International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: lymphomaLong-term results with radiotherapy for stage I–II follicular lymphomas☆
Introduction
Approximately 80% of patients with follicular lymphomas have Stage III or IV disease at the time of diagnosis (1). Consequently, there is relatively little information in the literature on the results with radiotherapy (RT) alone for Stage I or II follicular lymphomas.
Although few studies of follicular lymphomas have had median follow-up times >10 years, Besa et al. (2), Denham et al. (3), and MacManus and Hoppe (4) observed relapses 14–16 years after RT for Stage I–II follicular lymphomas. Hence, the curability of follicular lymphoma remains controversial. The optimal treatment approach, including RT fields and doses (5), also remains unclear.
The purpose of this retrospective study was to analyze the long-term results with RT for Stage I–II follicular lymphomas to learn about the effectiveness of RT in this setting and to elucidate ways to improve the therapeutic ratio.
Section snippets
Methods and materials
From September 1960 to October 1988, 248 previously untreated patients with Ann Arbor (6) Stage I or II low-grade follicular lymphoma were treated at the University of Texas M. D. Anderson Cancer Center. Pathologists at M. D. Anderson Cancer Center reviewed the tissue biopsy specimens in every case. Most of these patients were treated on protocols consisting of chemotherapy and RT, the results of which have been previously described 2, 7. One hundred patients with World Health Organization (8)
Results
Follow-up of the surviving patients (n = 20) was 3.5–28.7 years (median 19.0). The 15-year progression-free and overall survival rate for all 80 patients was 41% and 43%, respectively.
Local control as a function of the maximal dimension of the follicular lymphoma at the start of RT is depicted in Fig. 1. On the basis of these results, follicular lymphomas were divided into two groups: those measuring <3.0 cm (n = 118) and those measuring ≥3.0 cm (n = 54). For the lymphomas measuring 0.5–2.9 cm,
Discussion
The optimal total dose of RT for follicular lymphomas remains unclear (5). Arthur (16) reported that doses ranging from 20 to 30 Gy given in 10–15 fractions locally controlled all sites of lymphadenopathy in 27 patients with follicular lymphoma. Similarly, Kamath et al. (17) suggested that 30 Gy given in 15–20 fractions is sufficient for most low-grade lymphomas, except for small tumors in the orbit, for which 20–25 Gy given in 12–15 fractions may be sufficient. Cox et al. (18) reported that
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2019, BloodCitation Excerpt :Patients typically present with advanced-stage disease and are generally considered incurable, although with modern chemoimmunotherapy, median overall survival (OS) for this patient group is now approaching 15 to 20 years.1,2 For the minority with localized stage I or II disease, definitive radiotherapy (RT) can be curative, with historical series reporting 10-year disease-free survival rates of 40% to 50%, with few relapses seen beyond this time.3,4 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computerized tomography (PET-CT) is now considered the gold-standard imaging technique for staging FL.5,6
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Supported by Grants CA 6294 and CA 16672 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services.