Radiotherapy for Non-Hodgkin’s lymphoma: still standard practice and not an outdated treatment option

Abstract

Two large, recently published observational studies demonstate a clear down-trend in the use of radiotherapy (RT) over the last 15 years, both in the setting of follicular and diffuse large B-cell lymphoma. This change of practice might have a negative impact on clinical outcome. Even within the context of modern systemic therapy, omission of RT translates not only into a shorter progression-free survival (PFS), but also into a worse overall survival (OS). RT should therefore remain standard practice.This short review is aiming to summarize current guidelines and the best evidence available in the management of non-Hodgkin’s lymphoma. Potentially practice changing, ongoing trials will be highlighted.

Venetoclax Synergizes with Radiotherapy for Treatment of B-cell Lymphomas

“…Two types of radiotherapy are currently available for clinical use, RIT and external beam RT. While RIT generally provides a superior therapeutic index due to superior targeting, RIT is not recommended for all patients, and external beam modalities remain effective in many settings (5,47). In a study of DLBCL patients over the age of 60, RT consolidation after R-CHOP improved OS from 67 to 89% and PFS from 49 to 79% at five years, with no reported adverse effects (47).…”

“…In a study of DLBCL patients over the age of 60, RT consolidation after R-CHOP improved OS from 67 to 89% and PFS from 49 to 79% at five years, with no reported adverse effects (47). A review of NHL studies from 2004 through 2015 concluded that RT use in NHL has declined in the rituximab era, but that excluding RT decreases response rates and worsens toxicity in many disease sub-types (5). RT efficacy has improved with modified dosing and more nuanced approaches to identifying patients most likely to benefit (5,47).…”

“…A review of NHL studies from 2004 through 2015 concluded that RT use in NHL has declined in the rituximab era, but that excluding RT decreases response rates and worsens toxicity in many disease sub-types (5). RT efficacy has improved with modified dosing and more nuanced approaches to identifying patients most likely to benefit (5,47). Our findings suggest that adding venetoclax might further improve the therapeutic index of RT, even at reduced RT doses, and that this combination deserves consideration.…”

“…Radiotherapy (RT) is among the oldest cancer treatments in the modern era and remains an effective tool both as external beam RT (5), and as radioimmunotherapy (RIT), which combines the selectivity of antibody targeting with the effectiveness of irradiation (6–11). Radiation causes DNA strand breaks that ultimately increase the activity of pro-apoptotic members of the BCL-2 family (12,13), making RT a rational candidate for combination with BCL-2 inhibiting drugs.…”

Detecting the micro/nano physical properties of single lymphoma cells with atomic force microscopy

“…The most substantial advancement in the treatment of B-cell malignancieshas been achieved due to the invention of the monoclonal CD20 antibody rituximab [2][3][4]. Rituximab targeted therapy combined with traditional chemotherapy/radiotherapy can significantly improve the survival rate of patients with lymphoma [5]. This combination technology has become the mainstream option for B cell lymphoma treatment.…”