Times Not to Forget Radiotherapy When Treating Patients With Lymphoma

Charles A. Enke, MD


J Oncol Pract. 2019;15(4):167-172. 

In This Article

Low-dose Palliative Radiation Therapy for Follicular, Marginal Zone, and Mantle Cell Lymphoma

Low-dose radiation therapy consisting of either 4 Gy delivered in a single fraction or 4 Gy delivered in two fractions of 2 Gy each has been shown to be an effective form of palliation for indolent lymphomas. The FORT trial (ClinicalTrials.gov identifier: NCT00310167) demonstrated that 24 Gy in 12 fractions was superior to 4 Gy delivered in two fractions for definitive treatment of indolent lymphoma; however, a dose of 4 Gy was shown to be effective for palliation. Progression was observed in 4% of the target sites treated with 4 Gy; however, retreatment of these sites was possible because of the low doses of radiation used.[12] This approach has been used with equal efficacy for many indolent lymphomas including grades 1 and 2 follicular lymphoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). Even mantle cell lymphoma frequently responds to 2 Gy per fraction × 2 fractions (boom-boom). A group from Stanford published a retrospective series of 25 patients diagnosed with mantle cell lymphoma who were treated with 2 Gy per fraction × 2 fractions. They reported a complete response rate of 68% and a partial response rate of 20%.[13] I have used this approach extensively for palliation of even bulky mantle cell lymphoma with excellent results. The morbidity associated with such low doses of radiation is negligible, and palliation is frequently effective.