Nodal Follicular Lymphoma

Heinzelmann, Frank; Engelhard, M.; Ottinger, Hellmut; Bamberg, M.; Weinmann, Martin

doi:10.1007/s00066-010-2090-9

Cited by 18 publications

(8 citation statements)

References 58 publications

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“…Our PFS of 54% and OS of 59% at 10 years and 92% local control are consistent with previous radiation-only series published within the last 15 years [5], [6], [9], [15]–[26]. In these series stage I and II FL treated with RT alone produces PFS of 30–50%, OS of 60–70% at 10 years and local control in the range of 90–95%.…”

Section: Discussionsupporting

confidence: 91%

“…Observation alone is a reasonable option when potential toxicity from radiation out weighs its benefit because of the extent and location of the disease [4]. In the pre-rituximab era chemotherapy had not been convincingly shown to improve treatment results compared to radiation alone [5]. An analysis of 144 stage 1 (by bone marrow) FL patients grade I–II enrolled in the National Lymphocare data base with a median follow up of 57 months reported that patients who received either rituximab and chemotherapy (R-chemo) or R-chemo plus radiotherapy had significantly improved PFS but no difference in OS compared with patients receiving radiotherapy alone.…”

Section: Discussionmentioning

confidence: 99%

“…Follicular lymphoma grade described by the World Health Organization (WHO) [2] depends on the number of centroblasts per high power field. Current recommendations [3] are to treat limited stage FL with radiation but the slowly progressive nature of the disease allows treatment to be deferred until long after diagnosis and it is not known if the local control that can be achieved by radiation actually alters overall outcome [4], [5]. A study of larger vs. smaller RT volumes showed better freedom from relapse but no difference in survival [6].…”

Section: Introductionmentioning

confidence: 99%

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Early Stage W.H.O. Grade I and II Follicular Lymphoma Treated with Radiation Therapy Alone

et al. 2013

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ObjectivesThis retrospective study was undertaken to evaluate the outcome of patients with stage I or II (limited stage), grade I–II follicular non-Hodgkin’s lymphoma (FL) treated with radiation therapy (RT) alone as initial management.MethodsPatients with stage I or II and pathologically confirmed WHO grade I or II FL treated initially with RT alone between 1982 and 2008 were identified from a population based cancer registry.ResultsForty patients with a mean age 61.3 years at diagnosis were identified. The median follow up was 6.9 years from the end of radiation therapy. Stage was I (n = 26) and II (n = 14). None had B symptoms. The Follicular Lymphoma International Prognostic Index (FLIPI) was low risk in 26 patients and intermediate risk in 5. Doses ranged from 15 Gy to 48 Gy, with a median dose of 35 Gy. All patients achieved a complete clinical response (CR). 5 and 10 year overall survival (OS) was 86% and 59%, progression free survival (PFS) 67% and 54%. Age ≥60 at diagnosis was associated with reduced OS, p = 0.029, but did not affect PFS. No other clinical features including grade or FLIPI were significant for outcomes. Local failure was uncommon occurring in 8% (3/40) although this was 21% (3/14) of all recurrences.ConclusionsOS and PFS outcomes for radiation alone in limited stage low grade FL patients from this single institution study are consistent with previously published data. No predictors were prognostic for PFS. A dose of ≤35 Gy may be appropriate. In this highly selected homogeneous group the FLIPI loses discriminating ability. Local control is excellent, and a majority of patients are free of disease after 5 years.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early Stage W.H.O. Grade I and II Follicular Lymphoma Treated with Radiation Therapy Alone

et al. 2013

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“…The observed OS is in good agreement with published data in the literature about primary radiotherapy for stages I/II follicular lymphoma: two recent literature reviews reported 10-years OS rates ranging between 46% and 79% (weighted average of 63% in Heinzelmann et al) after primary radiotherapy using mostly IFI or EFI [11,12]. No obvious correlation of OS and irradiated volume is seen in this literature review.…”

Section: Discussionsupporting

confidence: 91%

Dosimetric consequences of translational and rotational errors in frame-less image-guided radiosurgery

et al. 2012

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BackgroundTo investigate geometric and dosimetric accuracy of frame-less image-guided radiosurgery (IG-RS) for brain metastases.Methods and materialsSingle fraction IG-RS was practiced in 72 patients with 98 brain metastases. Patient positioning and immobilization used either double- (n = 71) or single-layer (n = 27) thermoplastic masks. Pre-treatment set-up errors (n = 98) were evaluated with cone-beam CT (CBCT) based image-guidance (IG) and were corrected in six degrees of freedom without an action level. CBCT imaging after treatment measured intra-fractional errors (n = 64). Pre- and post-treatment errors were simulated in the treatment planning system and target coverage and dose conformity were evaluated. Three scenarios of 0 mm, 1 mm and 2 mm GTV-to-PTV (gross tumor volume, planning target volume) safety margins (SM) were simulated.ResultsErrors prior to IG were 3.9 mm ± 1.7 mm (3D vector) and the maximum rotational error was 1.7° ± 0.8° on average. The post-treatment 3D error was 0.9 mm ± 0.6 mm. No differences between double- and single-layer masks were observed. Intra-fractional errors were significantly correlated with the total treatment time with 0.7mm±0.5mm and 1.2mm±0.7mm for treatment times ≤23 minutes and >23 minutes (p<0.01), respectively. Simulation of RS without image-guidance reduced target coverage and conformity to 75% ± 19% and 60% ± 25% of planned values. Each 3D set-up error of 1 mm decreased target coverage and dose conformity by 6% and 10% on average, respectively, with a large inter-patient variability. Pre-treatment correction of translations only but not rotations did not affect target coverage and conformity. Post-treatment errors reduced target coverage by >5% in 14% of the patients. A 1 mm safety margin fully compensated intra-fractional patient motion.ConclusionsIG-RS with online correction of translational errors achieves high geometric and dosimetric accuracy. Intra-fractional errors decrease target coverage and conformity unless compensated with appropriate safety margins.

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“…They are commonly diagnosed in localized stages (Ann-Arbor stage I and II) and stay localized for a long time. Previous studies have shown excellent outcomes after radiotherapy in treatment of MALT lymphoma as an organ-preserving treatment modality [3] as has also been shown for other indolent lymphoma subtypes [4]. We report the outcomes of a retrospective analysis of 30 patients with stage I-II MALT-lymphoma treated with radiotherapy at our Institution.…”

Section: Introductionmentioning

confidence: 87%

Radiotherapy in marginal zone lymphoma

et al. 2013

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PurposeTo evaluate the efficacy of radiotherapy (RT) for early-stage nodal and extranodal marginal zone lymphoma (MZL).Materials and methodsPatients with stage I (n = 22) and stage II (n = 8) MZL, who were treated with RT were reviewed. The primary tumor localisation was in the orbita (n = 12), stomach (n = 8), head and neck other than the orbita (n = 8), breast (n = 1) and one case of marginal zone lymphoma of the skin (n = 1). The median radiotherapy dose was 40 Gy (5 to 45 Gy).ResultsThe median follow-up time was 103 months. The 5-year overall survival and event-free survival rates were 85 ± 7% and 71 ± 9%, respectively. There was no infield recurrence. Recurrence occurred outside of the radiation field in six patients. The relapses were treated with salvage RT and had excellent local control (100%) at five years after salvage RT.ConclusionsLocalized extranodal MZL have an excellent prognosis following moderate-dose RT. RT is also an effective salvage therapy in cases of localized recurrence. Further clinical studies should evaluate the optimal dose for MZL.

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Nodal Follicular Lymphoma

Cited by 18 publications

References 58 publications

Early Stage W.H.O. Grade I and II Follicular Lymphoma Treated with Radiation Therapy Alone

Early Stage W.H.O. Grade I and II Follicular Lymphoma Treated with Radiation Therapy Alone

Dosimetric consequences of translational and rotational errors in frame-less image-guided radiosurgery

Radiotherapy in marginal zone lymphoma

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