Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University.

Manus, Michael P. Mac; Hoppe, Richard T.

doi:10.1200/jco.1996.14.4.1282

Cited by 357 publications

(217 citation statements)

References 17 publications

Supporting

Mentioning

181

Contrasting

Unclassified

Order By: Relevance

“…Recurrences were more frequently observed in patients treated with EFI; however, there were imbalances of stage distribution and total irradiation dose and no multivariate analysis was performed. Mac Manus et al described the Stanford experience of 177 patients and differentiated between irradiation of the involved side or both sides of the diaphragm [4]. After a median follow-up of 7.7 years, FFP at 10 year were 36% and 67% for treatment of the involved side only and both sides of the diaphragm, respectively, which was highly significant.…”

Section: Discussionmentioning

confidence: 99%

“…As the site of treatment failure is most frequently nodal outside irradiated involved volumes, extended-field irradiation (EFI) or even total nodal irradiation (TNI) have been proposed to improve outcome compared to involved-field irradiation (IFI). While studies reported improved progression free survival (PFS) after treatment of larger volumes, this did not transfer into improved overall survival (OS) [4,5]. Despite the majority of relapses are observed within 5 years after radiotherapy, late recurrences 15 – 20 years after treatment [4-6] indicate the need for studies with long-term follow-up, which are scarce in the literature.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation

2012

View full text Add to dashboard Cite

BackgroundTo analyze long-term results of radiotherapy alone for stage I-III low grade follicular lymphoma and to compare outcome after extended field irradiation (EFI) and total nodal irradiation (TNI).Methods and materialsBetween 1982 and 2007, 107 patients were treated with radiotherapy alone for low grade follicular lymphoma at Ann Arbor stage I (n = 50), II (n = 36) and III (n = 21); 48 and 59 patients were treated with EFI and TNI, respectively. The median total dose in the first treatment series of the diaphragmatic side with larger lymphoma burden was 38 Gy (25 Gy – 50 Gy) and after an interval of median 30 days, a total dose of 28 Gy (12.6 Gy – 45 Gy) was given in the second treatment series completing TNI.ResultsAfter a median follow-up of 14 years for living patients, 10-years and 15-years overall survival (OS) were 64% and 50%, respectively. Survival was not significantly different between stages I, II and III. TNI and EFI resulted in 15-years OS of 65% and 34% but patients treated with TNI were younger, had better performance status and higher stage of disease compared to patients treated with EFI. In multivariate analysis, only age at diagnosis (p < 0.001, relative risk [RR] 1.06) and Karnofsky performance status (p = 0.04, RR = 0.96) were significantly correlated with OS. Freedom from progression (FFP) was 58% and 56% after 10-years and 15-years, respectively. Recurrences outside the irradiated volume were significantly reduced after TNI compared to EFI; however, increased rates of in-field recurrences and extra-nodal out-of-field recurrence counterbalanced this effect resulting in no significant difference in FFP between TNI and EFI. In univariate analysis, FFP was significantly improved in stage I compared to stage II but no differences were observed between stages I/II and stage III. In multivariate analysis no patient or treatment parameter was correlated with FFP. Acute toxicity was significantly increased after TNI compared to EFI with a trend to increased late toxicity as well.ConclusionsRadiotherapy alone for stage I and II follicular lymphoma resulted in long-term OS with high rates of disease control; no benefit of TNI over EFI was observed. For stage III follicular lymphoma, TNI achieved promising OS and FFP and should be considered as a potentially curative treatment option.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation

2012

View full text Add to dashboard Cite

show abstract

“…With the exception of a minority of patients who present with localized disease in which radiation therapy alone may have a curative role [2][3][4][5], it is considered a largely incurable disease. Disease progression is characterized by multiple relapses with spontaneous remission and transformation to more aggressive lymphomas in some cases.…”

mentioning

confidence: 99%

Response to low-dose involved-field radiotherapy in patients with non-Hodgkin's lymphoma

Luthy

Silver

et al. 2008

Annals of Oncology

View full text Add to dashboard Cite

Background: The purpose of this study was to analyze response to palliative low-dose involved-field radiotherapy (LD-IF-RT) (two 2-Gy fractions), explore factors predicting for response, and determine the time course to subsequent treatment.Patients and methods: Thirty-three patients with advanced or recurrent indolent non-Hodgkin's lymphoma (NHL) received LD-IF-RT to 43 sites. Response was assessed by physical examination and radiographic studies. Median follow-up for individual sites was 14 months. Fisher's exact test was used to evaluate prognostic factors for response and in-field progression.Results: Overall response was 95%. Thirty-six sites (84%) had a complete response (CR), five sites (12%) had a partial response, and two sites (5%) had progressive disease. The CR rate of head and neck sites was significantly higher than that of pelvic and/or inguinofemoral sites (95% versus 64%, P = 0.04). The CR rate was significantly higher for sites £40 mm than for sites >40 mm (90% versus 56%, P = 0.04). Ten sites (23%) had in-field progression diagnosed at a median of 9 months. Sixteen patients (48%) received systemic treatment at a median of 8 months. Fourteen patients (42%) did not require additional treatment.Conclusions: LD-IF-RT for selected NHL subtypes has excellent local CR and in-field control rates and may postpone the need for systemic therapy.

show abstract

“…Together, these 'indolent' diseases are characterized by a relatively long-median survival; 8-10 years in the case of FL (Gallagher et al, 1986;Horning, 1993) and the clinical course is typically one of multiple disease episodes, punctuated by variable periods of remission. The tumours are sensitive to external beam radiotherapy, as demonstrated by the long-periods of relapse-free survival observed in patients with early stage disease treated with this modality (Mac Manus and Hoppe, 1996). For the majority of patients however, who have advanced stage disease, an initial policy of observational management is not disadvantageous in the absence of symptoms or organ compromise (Ardeshna et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Radioimmunotherapy for B-cell lymphoma: Y90 ibritumomab tiuxetan and I131 tositumomab

Davies

2007

Oncogene

View full text Add to dashboard Cite

Radioimmunotherapy, targeting the CD20 antigen, in B-cell lymphoma has clearly demonstrated efficacy and tolerability over the preceding 15 years. As a result, two products are available with Food and Drug Administration approval for marketing -Y 90 ibritumomab tiuxetan and I 131 tositumomab, given as the Zevalin and Bexxar therapeutic regimens, respectively. Both demonstrate high-response rates and durability of remission in the relapsed/refractory disease setting. Data are emerging regarding their utility as initial therapy, and furthermore, they are been investigated for use sequentially with chemotherapy, and in the myeloablative setting. As yet however, how to best use these agents in the clinical disease course remains uncertain.

show abstract

Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University.

Abstract: Radiotherapy remains the treatment of choice for early-stage low-grade follicular lymphomas. Patients who have remained free of disease for 10 years are unlikely to relapse.

Cited by 357 publications

References 17 publications

Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation

Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation

Response to low-dose involved-field radiotherapy in patients with non-Hodgkin's lymphoma

Radioimmunotherapy for B-cell lymphoma: Y90 ibritumomab tiuxetan and I131 tositumomab

Contact Info

Product

Resources

About