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A high and sustained response rate in refractory or relapsing low-grade lymphoma masses after low-dose radiation: analysis of predictive parameters of response to treatment

2001; Elsevier BV; Volume: 51; Issue: 1 Linguagem: Inglês

10.1016/s0360-3016(01)01626-1

1879-355X

T. Girinsky, Dolores Guillot-Vals, Serge Koscielny, Jean-Marc Cosset, G. Ganem, Patrice Carde, Monique Monhonval, Renata Junqueira Pereira, Jacques Bosq, Vincent Ribrag, J Vantelon, Jean‐Nicolas Munck,

Effects of Radiation Exposure

To determine the efficacy of small doses of radiation in patients with recurrent or refractory low-grade lymphoma masses. Patients with refractory or relapsing low-grade lymphoma masses. The two largest diameters of the tumor mass were measured, whenever possible, before and after treatment. A dose of 4 Gy of radiotherapy was delivered to tumor sites in 2 fractions. Patients were evaluated for response 1–4 months later and at regular follow-up visits. Forty-eight patients with low-grade lymphomas according to the working formulation received low-dose radiotherapy between March 1987 and November 1998. Most patients had advanced disease at the time of radiation treatment, and 80% had received at least two chemotherapy regimens before treatment. The median interval between the initial diagnosis and radiotherapy was 2.7 years (range 0–22 years). Low-dose radiation was delivered to 135 tumor sites. Nodal and extranodal tumor sites represented 80% and 20% of masses, respectively. An objective response was obtained in 81% of the sites, with 57% attaining a complete remission. The 2-year actuarial freedom from local progression (FFLP) rate was 56% (95% CI, 46–66%). Tumor masses ≤5 cm in diameter had a significantly higher 2-year FFLP rate than larger masses (51% vs. 27%). It is noteworthy that the 2-year FFLP rate for patients treated with less than 2 chemotherapy regimens before radiotherapy was significantly higher than the 2-year FFLP rate for more heavily treated patients (96% vs. 48%). The 2-year FFLP rates for extranodal tumor sites and nodal sites were not significantly different. The tumor size (≤5 cm vs. >5 cm), the number of chemotherapy regimens (0–1 vs. more), and age at time of radiation treatment (≤65 years or > 65 years) were significant predictive parameters of response to treatment. In this retrospective study, low-dose radiation proved efficient, with long-lasting effects in the majority of patients with recurrent or refractory low-grade lymphomas. This simple and nontoxic treatment should be investigated prospectively in patients with advanced disease and a low tumor burden not immediately warranting chemotherapy.