Efficacy

No RCTs were found. An open study of 82 patients treated with PUVA and followed for up to 15 years reported an overall CR rate of 65% (79% for stage IA, 59% for stage IB and 83% for stage IIA disease) and mean cumulative doses of 134 J/cm2 (IA), 140 J/cm2 (IB) and 240 J/cm2 (IIA), with median time to CR of 3 months.27 Few patients with more advanced disease were treated, making interpretation of results for patients with stage >IIA difficult. In this study, 67% of stage IA, 41% of stage IB and 67% of stage IIA patients were free of disease at 2 years but maintenance PUVA was given to most patients.27 Survival rates at 5 and 10 years were 89% for stage IA, 78% for stage IB and, surprisingly, 100% for stage IIA.

A further open study of PUVA in 82 patients with CTCL showed CR in 62% of patients, with 88% CR in stage IA (mean cumulative PUVA dose 160 J/cm2), 52% in stage IB (498 J/cm2) and 46% in stage III disease (178 J/cm2). No responses were seen in stage IIB patients. The maximum duration of response was 68 months; 38% of complete responders relapsed despite maintenance PUVA.28

Although maintenance therapy has been recommended for responders, a further open study has shown that 56% of stage IA and 39% of stage IB patients with CR had no recurrence of CTCL during a maximum period of 44 months follow up, despite no maintenance therapy.29

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