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

High-dose Chemoradiotherapy and Autologous Transplantation for Relapsed or Primary Refractory Lymphoma

Caring for patients with lymphoma who either do not respond to initial systemic therapy (primary refractory lymphoma) or relapse after initially obtaining a complete remission represents a clinical challenge. The PARMA trial demonstrated the superiority of high-dose chemotherapy and autologous transplantation compared with conventional chemotherapy alone. Patients who were randomly assigned to undergo transplantation received radiation therapy for bulky disease (defined as greater than 5 cm or extranodal T3 to T4 lesions). Radiation therapy was delivered before transplantation and consisted of 1.3 Gy per fraction twice per day to 26 Gy. Conventional therapy also used radiation therapy (1.75 Gy/fraction × 20 fractions to 35 Gy) after chemotherapy for the same criteria, provided there was no disease progression during conventional chemotherapy. Patients in the high-dose arm had an improved 5-year event-free survival rate (46% v 12%) and overall survival rate (53% v 32%).[22] Radiation therapy was used in 40% of patients. The patients who received radiation therapy had fewer relapses (36% v 55%) compared with patients who did not receive radiation therapy, even though the irradiated group consisted of patients with bulky disease.[7] Patients who did not respond to salvage chemotherapy were not eligible for high-dose therapy. It is interesting to consider the potential impact of the two different radiation techniques used in the two arms on the observed outcome. A recent guidelines publication by the International Radiation Oncology Group on the role of radiation therapy in relapsed or refractory DLBCL is available.[7]