Journal of Clinical Oncology, Vol 14, 1282-1290, Copyright © 1996 by American Society of Clinical Oncology
Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University
MP Mac Manus and RT Hoppe
Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA.
PURPOSE: To evaluate retrospectively the results of radiotherapy for 177
patients with stage I (n = 73 [41%]) and II (n = 104 [59%]) follicular
small cleaved-cell and follicular mixed small cleaved-cell and large-cell
non-Hodgkin's lymphoma (NHL) treated in the Department of Radiation
Oncology, Stanford University between 1961 and 1994. PATIENTS AND METHODS:
Histology was follicular small cleaved-cell in 101 (57%) cases and
follicular mixed small cleaved-cell and large-cell in 76 (43%). Forty-five
patients (25%) had staging laparotomy; 34 (19%) had extranodal involvement.
All patients had received radiotherapy, either to one side of the diaphragm
(involved or extended field) or to both sides (total lymphoid irradiation
[TLI] or subtotal lymphoid irradiation [STLI]. Radiotherapy doses ranged
from 35 to 50 Gy. RESULTS: The median follow-up duration was 7.7 years. The
longest follow-up duration was 31 years. Actuarial survival rates at 5, 10,
15, and 20 years were 82%, 64%, 44%, and 35%, respectively. The median
survival time was 13.8 years. At 5, 10, 15, and 20 years, 55%, 44%, 40%,
and 37% of patients, respectively, were relapse-free. Only five of 47
patients who reached 10 years without relapse subsequently developed
recurrence. Survival and freedom from relapse (FFR) were significantly
worse for older patients. Relapse rates were lower following treatment on
both sides of the diaphragm or staging laparotomy. Univariate analysis
showed that youth and staging laparotomy were associated with significantly
better survival and that FFR was better following treatment on both sides
of the diaphragm or laparotomy. CONCLUSION: Radiotherapy remains the
treatment of choice for early-stage low-grade follicular lymphomas.
Patients who have remained free of disease for 10 years are unlikely to
relapse.
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