Radiation Oncology/NHL/Specific sites

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Front Page: Radiation Oncology | RTOG Trials | Randomized Trials

Non-Hodgkin lymphoma: Main Page | Randomized
Overview: Overview | Follicular | Diffuse large B-cell | MALT (extranodal marginal zone) | Nodal marginal zone | Mantle cell | CLL/SLL | Lymphoblastic | Burkitt | NK/T cell | Anaplastic large cell | Primary CNS Lymphoma
Treatment: Low grade and follicular | Diffuse and high grade | Marginal zone | Mantle cell | CLL/SLL | Lymphoblastic | Specific sites | Radioimmunotherapy


Contents

[edit] Primary CNS Lymphoma

[edit] Skin

[edit] Head & Neck

[edit] Waldeyer's Ring

See anatomic description at Radiation_Oncology/Hodgkin/Overview#Anatomy; traditional RT fields at Radiation_Oncology/Hodgkin/Overview#Radiation fields

Waldeyer's ring includes the tonsil, nasopharynx, and base of tongue.

  • Mexico (1981-91) — 1996 - Treatment of non-Hodgkin's lymphoma of Waldeyer's ring: radiotherapy versus chemotherapy versus combined therapy. (Aviles A, Eur J Cancer B Oral Oncol. 1996 Jan;32B(1):19-23.)
    • 316 pts. Phase III. Stage I NHL of Waldeyer's ring. Randomized to extended-field RT alone, chemotherapy alone (CHOP or CHOP-like), or combined therapy with chemo + RT.
    • Median f/u 6.8 yrs. CR in 93%, 87%, 97%. 5-yr FFS 48%, 45%, 83% (SS); OS 56%, 58%, 90% (SS).
    • Conclusion: improved results with combined chemo+RT.

[edit] GI tract

GI lymphomas account for 4-12% of all NHL and 1-4% of GI tumors. 20-40% involve the small bowel. There is a subtype called enteropathy-type intestinal T-cell lymphoma. [1]

[edit] Stomach

  • Italy; 2009 (1998-2004) PMID 19479614 -- "Early stage gastric diffuse large B-cell lymphomas: results of a randomised trial comparing chemotherapy alone versus chemotherapy + involved field radiotherapy." (Martinelli G, Leuk Lymphoma. 2009 May 19:1-7.)
    • Randomized. 54 patients, DLBCL gastric lymphoma. Antracycline-containing chemo x4-6 cycles. Those in CR (83%) randomized to Arm 1) IFRT vs Arm 2) 2 additional cycles of chemo
    • Outcome: LR RT significantly better. OS no difference
    • Conclusion: IFRT able to prevent local relapse
  • MSKCC, 2005 - PMID 15936555 — "Radiation treatment planning techniques for lymphoma of the stomach." Della Biancia C et al. Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):745-51.
    • Comparison of AP/PA vs 3D-CRT vs IMRT for different relationships of the target volume and kidneys.

[edit] Primary Mediastinal Large B-Cell Lymphoma (PMBCL)

  • Please see DLBCL/PMLBCL section for background information


Chemotherapy regimens: MACOP-B, VACOP-B, NHL-15, R-CHOP


  • Padova, 2007 (Italy) PMID 17379431 -- "Primary mediastinal large B-cell lymphoma: results of intensive chemotherapy regimens (MACOP-B/VACOP-B) plus involved field radiotherapy on 53 patients. A single institution experience." (Mazzarotto R, Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):823-9.)
    • Retrospective. 53 consecutive patients with PMLBCL (90% Stage I-II) treated with induction ProMACE-MOPP (n=2), MACOP-B (n=11), and VACOP-B (n=40), followed by IFRT. RT started 3-4 after chemo, modified mantle and SCV if involved at diganosis. Dose 30.6/17 - 39.6/22 (mean 36/20). Treatment completed in 80%. Median F/U 7.8 years
    • Outcome: 5-year OS 93%, DFS 87%. Response after chemo: CR 38%, PR 57%. If PR, 92% obtained CR after IFRT
    • Conclusion: Intensive chemo + IFRT efficacious; IFRT plays a pivotal role in inducing CR
  • Verona, 2004 (Italy)(1982-1999) PMID 14735179 -- "Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B." (Todeschini G, Br J Cancer. 2004 Jan 26;90(2):372-6.)
    • Retrospective. 13 Italian centers. 138 patients with PMLBCL treated with CHOP (n=43) or MACOP-B/VACOP-B (n=95). 76% patients in CR received IFRT
    • Outcome: CR CHOP 51% vs. MACOP-B/VACOP-B 80% (SS); EFS 40% vs. 76% (SS). IFRT improved outcome, irrespective of chemo
    • Conclusion: MACOP-B/VACOP-B better than CHOP; consolidation IFRT improves outcome in CR patients


  • Review - PMID 16720849, 2006 — "Primary mediastinal large B-cell lymphoma." Savage KJ. Oncologist. 2006 May;11(5):488-95.

[edit] References

  • ^  - PMID 10673521. Gale J et al. Enteropathy-type intestinal T-cell lymphoma: clinical features and treatment of 31 patients in a single center.
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