Low grade, indolent lymphomas of the head and neck: Comparative toxicity of standard versus very low dose radiation therapy Journal Article
| Authors: | Chelius, M.; Chau, K.; Yang, J.; Hajj, C.; Imber, B.; Yahalom, J. |
| Article Title: | Low grade, indolent lymphomas of the head and neck: Comparative toxicity of standard versus very low dose radiation therapy |
| Abstract: | National Comprehensive Cancer Network guidelines recommend radiation therapy (RT) for localized indolent non-Hodgkin lymphomas (iNHL). Many referring physicians avoid RT to the head and neck (HN) due to fears of toxicity. Very low-dose radiation (4 Gy) for select patients produces sustained local control and recently gained popularity. We compared early and late toxicities of standard 24–30 Gy to 4 Gy in patients with HN iNHL. We retrospectively analyzed 266 consecutive patients with HN iNHL receiving RT from 1994 to 2017. Patient characteristics, outcomes, and toxicities were collected from medical records. Early (≤2 months post-RT) and late (>2 months post-RT) toxicities were graded per Common Terminology Criteria for Adverse Events version 4. Grades 1–2 were defined as “low-grade” and 3–4 “high-grade.” Toxicity incidence was compared between 4 and >4 Gy, grouped by treated site (orbit, nonorbital head, neck, skin) and early versus late. Median follow-up was 23 months (2–145) and 68 months (2–256) for 4Gy and >4 Gy cohorts, respectively. Median dose for the >4 Gy cohort was 30 Gy (10.5–54 Gy). Early and late toxicity incidences were lower in the 4 Gy cohort compared to >4 Gy across all RT-sites: early toxicity, orbit, 42% versus 96%; nonorbital head, 24% versus 96%; neck, 22% versus 94%; skin, 31% versus 87%; late toxicity, orbit, 20% versus 71%; nonorbital head, 6% versus 66%; neck, 6% versus 57%; skin, 0% versus 46% (4 Gy vs. >4 Gy, respectively). Toxicities among both cohorts were largely low-grade. High-grade early and late toxicities did not occur in the 4 Gy cohort. There was 1 high-grade early toxicity (Grade 3 dry mouth) and 17 high-grade late toxicities (Grade 3 cataracts) in the >4 Gy cohort. RT to HN for iNHL is associated with minimal short- and long-term toxicity and excellent local control among 4 Gy and >4 Gy treatments. In this setting, “toxicity” concerns should not deter oncologists from potentially curative RT. In select patients where toxicity remains a concern, very low dose 4 Gy could be considered. © 2021 John Wiley & Sons Ltd. |
| Keywords: | toxicity; follicular lymphoma; marginal zone lymphoma; head and neck; indolent lymphoma; low-grade lymphoma |
| Journal Title: | Hematological Oncology |
| Volume: | 39 |
| Issue: | 3 |
| ISSN: | 0278-0232 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2021-08-01 |
| Start Page: | 304 |
| End Page: | 312 |
| Language: | English |
| DOI: | 10.1002/hon.2865 |
| PUBMED: | 33733514 |
| PROVIDER: | scopus |
| PMCID: | PMC10018679 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2021 -- Source: Scopus |
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