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High Response Rates and Lasting Remissions After Low-Dose Involved Field Radiotherapy in Indolent Lymphomas

From the Departments of Radiotherapy, Pathology, and Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; the Department of Radiotherapy, Bernard Verbeeten Institute, Tilburg, The Netherlands; the Department of Haematology, The Academic Medical Hospital, Amsterdam, The Netherlands., On behalf of the Haemato-Oncology Group of Amsterdam (HORA-Group).

Address reprint requests to R.L.M. Haas, MD, The Netherlands Cancer Institute, Department of Radiotherapy, Plesmanlaan 121, 1066 CX Amsterdam; email: r.haas{at}nki.nl.

Purpose: To study the response rates and duration of response after low-dose (4 Gy) involved field radiotherapy (LD-IF-RT) in patients with recurrent indolent lymphoma.

Patients and Methods: A total of 109 assessable patients (304 symptomatic sites) were irradiated (53 males and 56 females; median age, 62 years; range, 35 to 93), including 98 patients with follicular lymphoma (43 grade 1 and 55 grade 2), nine extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue-type and two patients with lymphoplasmacytoid lymphoma. Bulky disease (≥5 cm) was present in 52% of all patients. A median of two prior regimens (range, 0 to 11) preceded LD-IF-RT. The median time since diagnosis was 41 months (range, 2 to 358 months). Time to (local) progression was calculated according to the Kaplan-Meier method. Differences in response rates between treatments within the same patient were compared using the McNemar test.

Results: The overall response rate was 92%; complete response was reached in 67 patients (61%), partial response in 34 patients (31%), stable disease in six patients (6%), and progressive disease in two patients (2%). The median time to progression was 14 months. The median time to local progression was 25 months. The 67 patients with complete response showed a median time to progression of 25 months and a median time to local progression of 42 months. None of the factors studied (age, sex, follicular lymphoma grade, radiotherapy regimen, number of previous regimens and previous history, number of positive sites or largest lymphoma diameter) were found to be related to response rate.

Conclusion: LD-IF-RT is a valuable asset in the management of patients with follicular lymphoma and should be considered in patients with recurrent disease.

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