No RCTs were found. A retrospective review of 123 patients treated at one institution (1969-85) with whole-body once-daily application of topical mechlorethamine, (10-20 mg/ml; aqueous preparation from 1968 to1980 and ointment base from 1980 to 1985) until maximum response reported CR rates of 51% in IA, 26% in IB, 0% in IIB and 22% in stage III disease.17 There were no differences in outcome with the aqueous or ointment base. Fifty patients had received total skin electron beam (TSEB) therapy before topical mechlorethamine. Relapse occurred in 56% of patients who achieved CR, despite continued maintenance treatment for 1-2 years.17
A study of 117 patients reported CR in 76% with stage I disease, 45% with stage II and 49% with stage III patients within 2 years of therapy
What are the effects of topical therapy in mycosis fungoides?
(median response duration of 45 months).18 Patients in this study were allowed local radiotherapy for tumours and these were not excluded as responders. Overall 5-year survival for all patients in this study was 89%.
In a retrospective review of 331 patients (all stages; 1968-82) treated with topical mechlorethamine daily and with maintenance therapy daily or alternate days for at least 3 years for those with a CR, a complete remission lasting 4-14 years was observed in 20% but was confined to those with stage I A—IB.19 However, patients in this series were allowed other therapies including radiotherapy, TSEB, phototherapy and methotrexate to achieve a response. Subsequent relapse occurred in only 17% of these patients within 8 years of withdrawing therapy, suggesting that some patients with very early stage disease may have achieved a cure. Response rates were highest in early stages of disease (IA: 80%; IB: 68%; IIA: 61%; IIB: 49%; III: 60%; IVA:13%; IVB: 11%). Stage-specific 5/10 year survival rates were 94/89% (IA), 85/83% (IB), 82/67% (IIA), 59/31% (IIB), 75/49% (III), 20/13% (IVA) and 11/0% (IVB).19
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