Phase II study of palliative low-dose local radiotherapy in disseminated indolent non-Hodgkin’s lymphoma and chronic lymphocytic leukemia

Johannsson, Jakob; Specht, Lena; Mejer, Johannes; Jensen, Bente

doi:10.1016/s0360-3016(02)03050-x

Cited by 52 publications

(45 citation statements)

References 17 publications

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“…Responses were often rapid and treatment-related toxicity was effectively absent. These results compare favorably with previously published data which are summarized in Table 5 [7][8][9][10][11].…”

Section: Discussionsupporting

confidence: 91%

“…Johannsson et al [10] found that patients with chronic lymphocytic leukemia/small lymphocytic lymphoma were less likely to achieve a CR as compared with patients with follicular lymphoma (83% versus 17%). Most other studies, including our current study, however, predominantly consisted of patients with follicular lymphoma, rendering analysis by histology difficult.…”

Section: Discussionmentioning

confidence: 99%

“…The role of low-dose involved-field radiotherapy (LD-IF-RT) as palliative treatment for indolent lymphoma has been explored in several European studies [7][8][9][10][11]. These studies have consistently shown a high response rate with minimal treatment toxicity.…”

mentioning

confidence: 99%

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

Luthy

Silver

et al. 2008

Annals of Oncology

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Luthy

Silver

et al. 2008

Annals of Oncology

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“…High response rates are observed even with a low total dose of 4 Gy (2 Â 2 Gy) for follicular lymphomas treated for palliation. [11][12][13] In patients treated with local RT, prognostic factors predictive of a high risk of relapse included age, stage II disease, systemic symptoms, and tumour bulk. 5,6,8,14 Follicular grade 2 histology was also an adverse factor for relapse in one series.…”

Section: Stage I-ii Follicular Lymphomamentioning

confidence: 99%

Radiation therapy for localized low-grade non-Hodgkin's lymphomas

Tsang

Gospodarowicz

2005

Hematol. Oncol.

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The most common low grade B-cell non-Hodgkin's lymphomas are follicular lymphomas, and extranodal marginal zone lymphomas, also known as mucosa-associated lymphoid tissue (MALT) lymphomas. Localized presentations of follicular lymphoma occur in 20-30% of cases, while for MALT lymphomas, stage I-II disease presentations occur in 70-90%. These are radiation-sensitive lymphomas. Following moderate dose local radiation treatment (30-35 Gy) for these stage I and II low grade lymphomas, the clinical results indicate long-term local control and possible cure. While local control is achieved with minimal morbidity with involved-field radiation therapy, a significant proportion of patients relapse with systemic disease outside of radiation fields. For follicular lymphoma, this occurs in approximately 50% of patients after 15 years, and for non-gastric MALT lymphoma, 30-40% after 10 years. Although patients with relapsed systemic disease are not curable with chemotherapy, the disease often behaves in an indolent fashion and prolonged survival is observed. For gastric MALT lymphomas, radiation therapy is indicated in patients whose lymphoma did not respond to Helicobacter pylori eradication therapy, or in gastric lymphoma not related to this microorganism. The subject of causative agents responsible for non-gastric MALT lymphomas is under active study and the identification of putative microorganisms will lead to improved treatment strategies for these unusual lymphomas, similar to the success in gastric lymphomas over the last decade.

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“…Historically, treatment of bulky and symptomatic FL with low doses of EBRT has resulted in overall response rates of 82−95% and CR rates of 55−74% [Johannsson et al 2002;Haas et al 2003;Luthy et al 2008]. Given the concern of low response rates in bulky disease to RIT [Gokhale et al 2005], a combination of RIT with EBRT was previously evaluated.…”

Section: Discussionmentioning

confidence: 99%

Priming Radioimmunotherapy With External Beam Radiation in Patients With Relapsed Low-Grade Non-Hodgkin Lymphoma

Abuodeh

Ahmed

Echevarria

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Background: The aim of this study was to evaluate the outcomes of priming salvage radioimmunotherapy (RIT) with a low dose of external beam radiotherapy (EBRT) in patients with relapsed low grade non-Hodgkin lymphoma (LG-NHL). Methods: Patients who received salvage RIT with or without 2 × 2 Gy EBRT between March 2009 and February 2013 were retrospectively reviewed at a single institution. Planning target volume (PTV) for EBRT was created by adding a 1-2 cm expansion to the gross tumor volume depending on the anatomical location. Kaplan−Meier method via log-rank was employed to analyze the endpoints freedom from progression (FFP) and overall survival (OS). Results: We identified 22 patients who received salvage RIT without chemotherapy with a median follow up of 34 months. Of these, 9 (41%) patients were treated with EBRT immediately prior to RIT, and 13 (59%) received salvage RIT alone. Median FFP was not reached in patients who underwent combination treatment, while it was 9 months for patients treated with RIT alone (p = 0.02). OS for all patients at 36 months was 80.3% with no significant difference between the two groups (p = 0.88). On univariate analysis, the addition of EBRT was associated with improved FFP [hazard ratio (HR) = 4.17; 95% confidence interval (CI), 1.24-19.1; p = 0.02)]. No long term toxicities were reported in both groups. Conclusions: RIT outcomes and effects were improved with addition of low-dose EBRT immediately prior to it, in the treatment of relapsed LG-NHL with no additional toxicity. This study is hypothesis-generating and the findings should be validated in prospective studies.

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Phase II study of palliative low-dose local radiotherapy in disseminated indolent non-Hodgkin’s lymphoma and chronic lymphocytic leukemia

Cited by 52 publications

References 17 publications

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

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

Radiation therapy for localized low-grade non-Hodgkin's lymphomas

Priming Radioimmunotherapy With External Beam Radiation in Patients With Relapsed Low-Grade Non-Hodgkin Lymphoma

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