First line phototherapy in early stage MF patients: The results of a large cohort retrospective study.
Nikolaou V, Sachlas A, Papadavid E, Economidi A, Karambidou K, Marinos L, Stratigos A, Antoniou C.
Background: Phototherapy is one of the main treatments for mycosis fungoides (MF). The purpose of this study was to analyze the efficacy and safety of phototherapy as a first line treatment in patients with early stage disease.
Methods: We analyzed the response to treatment, relapse – free interval and irradiation dose in 235 early stage patients (IA and IB), of whom 52 were treated with UVB-NB and 183 with PUVA. For data analysis the chi-squared test, the parametric t-test and ANOVA test and the nonparametric tests of Mann-Whitney and Kruskal-Wallis were applied.
Results: 147 males (62.6%) and 88 females (37.4%) were treated with phototherapy in our department. 53.8% of patients reached complete remission (CR) with UVB-NB and 76.5% with PUVA (p=0.015). Patients with patch stage disease had better response rates to PUVA compared to UVB-NB (CRs 56.6% vs 91.4%, p<0.001). Half of the patients relapsed in both treatment groups. Patients treated with PUVA had longer time-to-relapse compared with UVB-NB, although differences were not statistically significant (9.8 vs 24.5 months, p=0.122). In patients treated with UVB-NB, long lasting disease was proven as a negative prognostic factor for treatment outcome. Patients with folliculotropic disease had worse treatment outcome compared to patients with classic or poikilodermic MF, whereas there was no relevant effect of tumor cell immunophenotype or PCR analysis. Phototypes I&II were found to be favorable prognostic factors for patients treated with PUVA, whereas sessions/week had no effect on treatment outcome or time to response. Maintenance treatment did not alter relapse rates but led to longer time to relapse compared to no maintenance cases (22.3 months, vs 31.44, p<0.006)
Conclusions: Our study is the largest cohort to date in MF patients treated with phototherapy. Although recent data support that UVB-NB is equally effective with PUVA in patch stage disease, our analysis indicates that PUVA treatment leads to better responses and relapse free intervals both in patch and plaque stage disease. UVB-NB could be a valid therapeutic alternative for patients with recent disease appearance.