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Nodal Follicular Lymphoma

The Role of Radiotherapy for Stages I and II

Nodales follikuläres Lymphom. Rolle der Strahlentherapie in den Stadien I und II

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Purpose:

To clarify the role of external-beam radiotherapy (RT) in patients with stage I and II nodal follicular lymphoma (FL).

Methods:

The literature was reviewed with respect to different treatment strategies in patients with stage I and II nodal FL by screening the PubMed databank.

Results:

In patients with stage I and II nodal FL, RT alone with different irradiation techniques (involved-field [IFI]/extenedfield [EFI]/total nodal [TNI]/total lymphoid irradiation [TLI]) produces excellent local disease control (~ 95%) resulting in disease-free survival and overall survival (OS) rates of 37–94% and 40–93% at 5–15 years, respectively. The main cause of failure is out-of-field recurrence. In nonrandomized trials, IFI led to higher relapse rates, but larger irradiation volumes failed to show an impact on OS and were associated with increased toxicity. Additional chemotherapy mostly failed to improve treatment results achieved with RT alone.

Conclusion:

Since there is no evidence so far that the prognosis of stage I and II nodal FL can be improved by the use of EFI/TNI/TLI, IFI is recommended internationally. Adequate irradiation doses range between 25–30 Gy to subclinical disease and 36–40 Gy to involved sites. To further improve the curative potential of RT in early-stage FL, novel combined approaches (e.g., RT + immunotherapy with rituximab) are under investigation.

Ziel:

Analyse zur Rolle der externen Strahlentherapie (RT) bei Patienten mit nodalem follikulärem Lymphom (FL) in den Stadien I und II.

Methodik:

Hierzu wurde eine Literaturrecherche unter Verwendung der PubMed-Datenbank hinsichtlich unterschiedlicher Behandlungsstrategien bei Patienten mit Stadium I und II eines nodalen FL durchgeführt.

Ergebnisse:

Bei Patienten mit Stadium I/II eines nodalen FL bewirkt die RT mit Anwendung unterschiedlicher Techniken („involved-field“ [IFI]/„extended-field“ [EFI]/total nodal [TNI]/total lymphatisch [TLI]) eine ausgezeichnete lokale Kontrolle (~ 95%), die zu einem krankheitsfreien Überleben bzw. einem Gesamtüberleben von 37–94% bzw. 40–93% nach 5–15 Jahren führt. Die Hauptursache für das Therapieversagen stellen Rezidive außerhalb des RT-Zielvolumens dar. In nichtrandomisierten Studien konnten großvolumige Bestrahlungen – im Vergleich zu IFI – trotz einer geringeren Rückfallrate das Gesamtüberleben bei erhöhter Toxizität nicht entscheidend verbessern. Durch eine zusätzliche Anwendung der Chemotherapie ließen sich die Ergebnisse im Vergleich zur alleinigen Strahlentherapie zumeist nicht verbessern.

Schlussfolgerung:

Da bei Patienten mit Frühstadien eines nodalen FL bislang durch die Anwendung der EFI/TNI/TLI keine Prognoseverbesserung nachweisbar war, wird international eine IFI angeraten. Die empfohlene Dosis beträgt 25–30 Gy bei subklinischem Befall und 36–40 Gy bei manifestem Befall. Um das kurative Potential der externen RT bei Patienten mit Frühstadien eines FL weiter zu verbessern, werden kombinierte Behandlungsansätze (z.B. RT + Immuntherapie mit Rituximab) derzeit prospektiv untersucht.

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Heinzelmann, F., Engelhard, M., Ottinger, H. et al. Nodal Follicular Lymphoma. Strahlenther Onkol 186, 191–196 (2010). https://doi.org/10.1007/s00066-010-2090-9

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  • DOI: https://doi.org/10.1007/s00066-010-2090-9

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