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

Definitive Radiation Therapy for Early-stage Nodal Low-grade Follicular and Marginal Zone Lymphoma

Follicular lymphoma most commonly presents at advanced stages; however, somewhere between 22% and 33% of patients will present with stage I or contiguous stage II disease.[14] National Comprehensive Cancer Network (NCCN) Guidelines for B-Cell Lymphomas (version 4.2018) recommend consideration of definitive radiation therapy for patients presenting with nonbulky stage I or contiguous stage II follicular lymphoma, grades 1 and 2 as a first line of treatment. Unfortunately, the LymphoCare study showed that this recommendation is frequently not followed. In patients with stage I follicular lymphoma, radiation therapy monotherapy was used in 23.4% of patients and an additional 8% of patients received radiation therapy immediately after chemotherapy. Rituximab alone was used in 12.9% of patients and chemotherapy and rituximab were used in 30.4% of patients, while observation was used in 28.7% of patients who were potentially curable with radiation therapy.[15] Radiation doses of 24 to 30 Gy are generally recommended using ISRT.[5] A large SEER database analysis, including 6,568 patients diagnosed with follicular lymphoma stage I or II, identified the use of upfront definitive radiation therapy in 34% of patients. The use of early radiation therapy was associated with significantly higher rates of disease-specific survival compared with other therapies at 5 years (90% v 81%), 10 years (79% v 66%), and 20 years (63% v 51%). Improved overall survival was observed in patients treated with radiation therapy initially after diagnosis.[14]