Masterclass 8 - Emerging Technologies for Cancer Therapy

Total body electron beam therapy, also known as total skin electron beam therapy (TSEBT), is an important radiotherapy treatment modality for cutaneous lymphoma, a rare form of lymphoma characterized by widespread involvement of the skin. It is estimated the incidence of cutaneous lymphoma of 1:10000 annually. TSEBT is a highly specialized technique that delivers radiation to the entire surface area of the skin. It was once considered a potentially toxic treatment, but emerging evidence has demonstrated that lower doses of TSEBT can be an effective strategy with excellent outcomes.


The implementation of TSEBT at Pamela Youde Nethersole Eastern Hospital (PYNEH) began in October 2020. This process involved the collaborative efforts of clinical oncologists, physicists, and radiotherapists who worked together in treatment planning, delivery, and dosimetry monitoring. The multidisciplinary approach ensures that the treatment is tailored to each patient's clinical condition and maximizes the therapeutic benefits while minimizing potential side effects.


In an upcoming presentation, the role of TSEBT as part of a multimodality treatment approach in cutaneous lymphoma will be highlighted. The workflow and treatment delivery procedure will be discussed, shedding light on the technical aspects of TSEBT administration. Additionally, the presentation will delve into the clinical outcomes and toxicities observed in six patients who underwent low-dose TSEBT since October 2020.It is hoped to provide insights into its implementation and contributes to the growing body of knowledge of TSEBT and its role in managing cutaneous lymphoma.

As a rare cancer, treatment options for neuroendocrine tumour (NET) after failing initial therapy had been limited. Not until 2018, the Food and Drug Administration (FDA) approved a peptide receptor radionuclide therapy (PRRT), lutetium-177 dotatate for adult patients with advanced NETs affecting the pancreas or gastrointestinal tract. PRRT is a type of targeted radionuclide therapy which involves the systemic administration of therapeutic peptides labelled with radionuclides that selectively target cancer cells. The receptor-peptide complex is internalized via endocytosis and the radionuclide is preferentially retained by the receptor-expressing tumour cells. This process can lead to cell death, as the radiation-particles released by radionuclide primarily cause DNA single-strand breaks. Majority of NETs express somatostatin receptor, therefore radiolabelled somatostatin analogs are the preferred choice for PRRT. Beta particles are released by lutetium-177 in these tumour cells.
Benefit for lutetium-177 dotatate was shown in the phase III international NETTER-1 trial. 230 patients with inoperable, somatostatin-receptor-positive gastrointestinal NETs who experienced progressive disease on standard doses of octreotide LAR (i.e., 30 mg every 28 days) were randomly assigned to lutetium-177 dotatate plus continuation of standard dose of octreotide LAR or octreotide LAR 60 mg every 28 days. The estimated PFS rate at month 20 was significantly higher with lutetium-177 dotatate (65.2 versus 10.8 %, hazard ratio 0.21 [95% confidence interval 0.13-0.33]). Lutetium-177 dotatate also associated with a significantly higher objective response rate (18 versus 3 %). The most common adverse event in the Lutetium-177 dotatate group was nausea (all grade: 59%; grade 3/4: 4 %), thought to be due to the amino acid infusions administered during therapy to protect the kidneys. Hematologic toxicities included mostly mild degrees of thrombocytopenia (25%), lymphopenia (all grade: 18%; grade 3/4: 9%, anemia (14%), and leukopenia (10%).