Extended field and total central lymphatic radiotherapy in the treatment of early stage lymph node centroblastic-centrocytic lymphomas : Results of a prospective multicenter study
✍ Scribed by Martin Stuschke; Angela Hoederath; Horst Sack; Richard Pötter; Rolf-P. Müller; Ulrich Schulz; Johann Karstens; Hans-B. Makoski
- Publisher
- John Wiley and Sons
- Year
- 1997
- Tongue
- English
- Weight
- 134 KB
- Volume
- 80
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
Background:
A prospective multicenter trial was performed to evaluate survival, patterns of relapse, and toxicity for clinically staged patients with lymph node centroblastic-centrocytic (cb/cc) lymphomas in stages i-iiia after large extended field irradiation (efi) or total central lymphatic irradiation (tcli).
Methods:
Between january 1986 and august 1993, 117 adults with clinical stage i-iiia lymph node cb/cc lymphoma (kiel classification) were recruited. patients in stages i or ii with mediastinal, hilar, periaortic, iliac, or mesenteric involvement and in stage iiia received tcli, whereas patients with more peripherally located cb/cc lymphomas were treated with efi. tcli and efi were administered to a total dose of 26 gray (gy) with 2 gy per daily fraction, with the exception of the whole abdomen, which was irradiated to a total dose of 25.5 gy with 1.5 gy per fraction. a boost of 10 gy with 2 gy per fraction was administered to enlarged and involved lymph nodes at the start of radiotherapy.
Results:
Sixty, 40, and 17 patients had stage i, ii, and limited iiia disease (no bulk and less than 6 involved lymph node regions), respectively. overall survival was 86% at 5 and 7 years; median follow-up was 68 months. the probabilities of relapse at any site, recurrences in lymph nodes, and in-field lymph node recurrences after tcli were 17% in stage i; 56%, 43%, and 40% in stage ii, respectively; and 44%, 35%, and 35% in stage iiia, respectively. the risk of disseminated extralymphatic relapses was 9% at 7 years. the most important adverse prognostic factor for in-field lymph node recurrences was a deviation of >20% from the assigned total radiation dose. after efi, patients in stage i had a significantly lower risk of recurrences in adjuvant irradiated lymph node regions than in unirradiated lymph node regions. acute toxicity of efi and tcli was moderate.
Conclusions:
In-field lymph node recurrences remained the main risk after tcli, and a deviation of >20% from the assigned radiation dose was the major risk factor for in-field recurrences. from these data, a total dose of 40-44 gy in conventional fractionation for the treatment of macroscopic cb/cc lymphomas and 30 gy for the treatment of subclinical disease is recommended. a randomized study comparing tcli with efi is now being organized by this group.