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

Abstract

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.

Localized Low-Dose Radiotherapy for Follicular Lymphoma: History, Clinical Results, Mechanisms of Action, and Future Outlooks

“…In the late 1970s, RT was recommended as the treatment of choice for Stages I and II. The optimal (or conventional) dose of curative RT for localized disease derived from these early studies was considered to be [30][31][32][33][34][35]8) and was confirmed in subsequent main reports (9)(10)(11). Extended fields, particularly total lymphoid irradiation according to the patterns of spread of Hodgkin's disease, are no longer used.…”

“…Since that pioneering report (25), at least eight series of patients with NHL treated with localized LDRT have been reported ( Table 1) (25)(26)(27)(28)(29)(30)(31)(32). In at least five of them, the patients were treated before the era of anti-CD20 monoclonal antibodies.…”

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

“…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.…”

Good things come in small packages: low-dose radiation as palliation for indolent non-Hodgkin lymphomas

“…There have been numerous reports now of the use of low-dose IFRT in the palliative setting for patients with both indolent and aggressive NHL [23][24][25][26][27][28][29][30][31][32]. Although initially used mainly in the indolent forms, the recent reports, based on limited number of cases, have highlighted the possibility that it may also be useful for more aggressive histologies, although the response rates may be lower.…”

“…For this typically elderly population, systemic therapy can be associated with significant toxicity and resistance to treatment can develop. Conventionaldose involved-field radiation therapy (IFRT) to [30][31][32][33][34][35][36][37][38][39][40] Gy can also be utilized to produce durable control. However, the side effects of conventionaldose radiation therapy to some sites, such as the head and neck area, can affect quality of life and for other treatment fields such as large pelvic fields, bone marrow reserve can be compromised.…”