Radiation Oncology/NHL/Specific sites

Primary CNS Lymphoma

• Please see Primary CNS Lymphoma for detailed information

Skin

• Please see Mycosis fungoides for T-cell lymphoma or Cutaneous B-cell lymphoma

Head & Neck

Thyroid

See page at Thyroid lymphoma

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.

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.

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.

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

Treatments:

• 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

Clinicopathologic Studies:

• Nebraska - PMID 10071267, 1999 -- "Primary mediastinal large B-cell lymphoma: a clinicopathologic study of 43 patients from the Nebraska Lymphoma Study Group." (Abou-Elella AA, J Clin Oncol. 1999 Mar;17(3):784-90.)
  • Conclusion: The clinical features of PMLBL do not appear to be significantly different from those of nonmediastinal DLBL. Younger median age of 42 yrs is much less than median age for nonmediastinal DLBL.

Reviews:

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

Testicular

• International Extranodal Lymphoma Study Group 10 [IELSG-10] - Phase II - R-CHOP, IT-MTX, RT to contralateral testis
  • Multinational. 53 pts, Stage I-II primary testicular lymphoma. R-CHOP21 x 6-8, 4 doses of intrathecal MTX, RT 30 Gy to the contralateral testis (for all pts). RT 30-36 Gy given to the pelvis for Stage II.
  • 2011 No PMID yet -- "First-Line Treatment for Primary Testicular Diffuse Large B-Cell Lymphoma With Rituximab-CHOP, CNS Prophylaxis, and Contralateral Testis Irradiation: Final Results of an International Phase II Trial." (Vitolo U, JCO online before print June 6, 2011.)
    • Median f/u 65 mo. All pts received R-CHOP, 50 received CNS prophylaxis, 47 received testicular RT. 5-yr PFS 74% and OS 85%. 10 pts with relapses: 2 in LNs, 5 in extranodal organs, 3 in CNS. 5-yr CNS relapse rate 6%. No contralateral testis relapses. 10 pts died (6 from lymphoma).
    • Conclusion: Good outcome for PTL with chemotherapy with CNS prophylaxis and RT to the contralateral testis. CNS prophylaxis deserves further investigation.

References

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