4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non-inferiority trial

Hoskin, Peter; Kirkwood, Amy A.; Popova, Bilyana; Smith, Paul J.; Robinson, Martin; Gallop‐Evans, Eve; Coltart, Stewart; Illidge, Tim; Madhavan, Krishnaswamy; Brammer, Caroline; Díez, Patricia; Jack, Andrew; Syndikus, Isabel

doi:10.1016/s1470-2045(14)70036-1

Cited by 207 publications

(159 citation statements)

References 8 publications

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“…Lower radiation doses (such as 4 Gy in 2 fractions) have also been evaluated for patients with indolent lymphomas, such as marginal zone lymphoma and follicular lymphoma of nonocular sites [36]. In a randomized phase 3 noninferiority trial, local progression-free survival was inferior with 4 Gy (2 fractions) compared to 24 Gy (12 fractions), establishing the higher dose as the standard of care [37]. …”

Section: Discussionmentioning

confidence: 99%

Extranodal Marginal Zone Lymphoma of Ocular Adnexa: Outcomes following Radiation Therapy

Platt¹,

Zahrani²,

Singh

et al. 2017

Ocul Oncol Pathol

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Aim: The aim of this study was to report outcomes following radiation therapy in patients with biopsy-proven extranodal marginal zone lymphoma of the ocular adnexa and uvea. Methods: Records from a single institution were retrospectively reviewed from January 1997 to December 2015. The mean follow-up duration was 38 months (range 0-194). Radiation therapy was administered to 77 eyes (60 patients); 57 of the 77 eyes (74%) were treated with radiation only (range 20-36 Gy, median 15 fractions). Radiation cataract, radiation retinopathy, and optic neuropathy assessments were performed on all eyes treated with radiation. Results: 100% of the 47 patients treated with radiation therapy only had local control with an average dose of 26.5 Gy (median 25.2 [range 20-36] Gy; 150-200 cGy per fraction). Four patients lost 2 lines or more of vision after radiation. The most common complication of radiation therapy was cataract formation/progression in 19 eyes (25%). Radiation retinopathy was observed only in 1 patient (1%). Conclusion: Our results confirm that radiation therapy (median 25 Gy) for extranodal marginal zone lymphoma of the ocular adnexa is associated with high local control and low risk of visually significant complications.

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Section: Discussionmentioning

confidence: 99%

Extranodal Marginal Zone Lymphoma of Ocular Adnexa: Outcomes following Radiation Therapy

Platt¹,

Zahrani²,

Singh

et al. 2017

Ocul Oncol Pathol

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“…12 It has long been believed that radiation is immunosuppressive, because normal hematopoietic cells and hematologic malignancies appear to be very sensitive to low radiation doses. 13 However, a collective body of work suggests that the effects of RT are multifaceted and may serve as an immune stimulus. Therefore, ultimate tumor control likely depends on a balance of immunosuppressive and immunostimulatory signals generated within the tumor.…”

Section: Immunologic Effects Of Rtmentioning

confidence: 99%

Irradiation and immunotherapy: From concept to the clinic

Salama

Postow

Salama

2016

Cancer

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In recent years, an increased understanding of T‐cell–regulatory mechanisms has led to the development of a novel class of immune‐checkpoint inhibitors that have robust clinical activity against a broad array of malignancies—even those that historically were not believed to be sensitive to immune therapy. With this, there has been renewed interest in the potential for synergy with more traditional forms of anticancer therapy like radiation therapy (RT). The role of RT in palliation or as definitive treatment for certain malignancies has been well established. Yet, in recent years, the concept has come to light that RT could be an attractive partner for use in combination with other immunotherapies. The effects of RT include not only control of an irradiated tumor but also multiple immunomodulatory effects on both the tumor and the microenvironment, priming tumors for an immune‐mediated response. Herein, the authors summarize relevant preclinical data and rationale supporting the synergy of combined RT and immunotherapy and highlight recent clinical work on promising combination strategies. Cancer 2016;122:1659‐71. © 2016 American Cancer Society.

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“…However, some patients develop refractory lymphomas that are resistant to all types of chemotherapy and require palliative treatment. [1][2][3][4][5][6][7][8][9][10][11][12] Several studies have demonstrated the value of low-dose involved-field radiotherapy (LD-IF-RT) at doses of up to 4 Gy in recurrent follicular lymphoma. [1][2][3][5][6][7][9][10][11] In contrast, there are few reports on the administration of palliative radiotherapy to patients with aggressive lymphoma 4,8,12 .…”

Section: Introductionmentioning

confidence: 99%

“…Due to the histological nature of both indolent and aggressive lymphomas, their sensitivity to radiation therapy varies. 11 Lowry et al reported that 24 Gy is an effective dose for indolent NHL, while a randomized controlled trial found that the effective dose for aggressive NHL is 30 Gy 10 Patients with refractory aggressive lymphoma are treated with more intensive chemotherapy than those with refractory indolent lymphoma.…”

Section: Introductionmentioning

confidence: 99%