Overall and cause-specific survival are high in early-stage extra-nodal MZL. Curative-intent treatment led to fewer relapses and reduced the need for salvage. Stomach cases had lower risk of relapse than other anatomic primary sites. This study supports the use of local therapies to treat stage IE and IIE MZL.

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Purpose We report the long-term results of integrated accelerated involved-field radiotherapy (IFRT) followed by total lymphoid irradiation (TLI) as part of the high-dose salvage regimen followed by autologous bone marrow transplantation (ABMT) or autologous stem-cell transplantation (ASCT) in patients with relapsed or refractory Hodgkin lymphoma (HL). Methods and Materials From 11/1985 to 07/2008, 186 previously unirradiated patients with relapsed/refractory HL underwent salvage therapy on four consecutive IRB-approved protocols. All patients had biopsy-proven primary refractory or relapsed HL. After standard-dose salvage chemotherapy (SC), accelerated IFRT (18–20 Gy) was given to relapsed/refractory sites, followed by TLI (15–18 Gy) and high-dose chemotherapy (HDT). Overall survival (OS) and event-free survival (EFS) were analyzed by Cox analysis and disease-specific survival (DSS) by competing risk regression. Results With a median follow-up of 57 months among survivors, 5- and 10-year OS was 68% and 56%, 5- and 10-year EFS was 62% and 56%, and 5- and 10-year cumulative incidence of HL-related deaths was 21% and 29%, respectively. On multivariable analysis, complete response (CR) to SC was independently associated with improved OS and EFS. Primary refractory disease and extranodal disease were independently associated with poor DSS. Eight patients had grade ≥3 cardiac toxicity with 3 deaths. Ten patients developed second malignancies, five of whom died. Conclusion Accelerated IFRT followed by TLI and HDT is an effective, feasible, and safe salvage strategy for patients with relapsed/refractory HL with excellent long-term OS, EFS, and DSS. CR to SC is the most important prognostic factor.

Purpose This prospective single-institution study examines the impact of positron emission-tomography (PET) using 2-[18F] fluoro-2-deoxyglucose and CT scan radiation treatment planning (TP) on target volume definition in lymphoma. Methods and Materials 118 patients underwent PET/CT TP during 6/2007-5/2009. Gross tumor volume (GTV) was contoured on CT-only and PET/CT studies by radiation oncology (RO) and nuclear medicine (NM) for 95 patients with positive PET scans. Treatment plans and dose-volume histograms were generated for CT-only and PET/CT for 95 evaluable sites. Paired t-test statistics and Pearson correlation coefficients were used for analysis. Results 70 (74%) patients had non-Hodgkin lymphoma, 10 (11%) had Hodgkin lymphoma, 12 (10%) plasma-cell neoplasm, and 3 (3%) other hematologic malignancies. Forty-three (45%) presented with relapsed/refractory disease. Forty-five (47%) received no prior chemotherapy. The addition of PET increased GTV as defined by RO in 38 patients (median, 27%; range, 5-70%) and decreased GTV in 41 (median, 39.5%; range, 5-80%). The addition of PET increased GTV as defined by NM in 27 patients (median, 26.5%; range, 5-95%) and decreased GTV in 52 (median, 70%; range, 5-99%). Intra-observer correlation between CT-GTV and PET-GTV was higher for RO than for NM (0.94, P < .01 vs. 0.89, P < .01). Based on Bland-Altman plots, the PET-GTVs defined by RO were larger than NM. On evaluating clinical TPs, only four (4%) patients had inadequate target coverage (D95<95%) of the PET-GTV defined by NM. Conclusions Significant differences between RO and NM volumes were identified when PET was co-registered to CT for radiation planning. Despite this, the PET-GTV defined by RO and NM received acceptable prescription dose in nearly all patients. However, given the potential for a marginal miss, consultation with an experienced PET reader is highly encouraged when delineating PET/CT volumes, particularly for questionable lesions and to assure complete and accurate target volume coverage.