Low dose palliative radiotherapy for refractory aggressive lymphoma

Abstract

Aim

To determine the efficacy of low-dose palliative radiotherapy in patients with refractory aggressive lymphoma.

Background

There are few reports on the administration of palliative radiotherapy to patients with aggressive lymphoma.

Materials and methods

The present study included 11 patients with 30 sites of aggressive lymphoma (diffuse large cell lymphoma, n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]7; mantle cell lymphoma, n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]2; follicular large cell lymphoma, n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]1; and peripheral T cell lymphoma, n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]1). The patients received local palliative radiotherapy after receiving a median of 4 chemotherapy regimens. The radiotherapy doses administered to the 30 sites were as follows: 8[[ce:hsp sp="0.25"/]]Gy, single fraction (n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]27); 6[[ce:hsp sp="0.25"/]]Gy, single fraction (n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]1); 4[[ce:hsp sp="0.25"/]]Gy, single fraction (n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]1); and 4[[ce:hsp sp="0.25"/]]Gy, 2 fractions (n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]1).

Results

The complete response rate was 45% (5/11); the partial response rate was 36% (4/11). Toxicity occurred at one irradiated site (the mandibular), which showed temporal acute gingivitis; however, medication was not required. Retreatment was required for 3 sites on the head (parotid, face and mandible) due to persistent discomfort. None of the other sites (27/30) required retreatment. A patient with refractory DLBCL underwent radiotherapy (4[[ce:hsp sp="0.25"/]]Gy, single fraction) for hepatic hilar lymph node involvement but did not recover from jaundice and died of DLBCL.

Conclusions

Eight Gray single fraction radiotherapy was one of meaningful options for the treatment of refractory aggressive lymphoma in terms of its efficacy and the incidence of adverse events. The use of 8[[ce:hsp sp="0.25"/]]Gy single fraction radiotherapy is therefore recommended for achieving local control in patients with refractory aggressive lymphoma.