Excellent response to very-low-dose radiation (4 Gy) for indolent B-cell lymphomas: Is 4 Gy suitable for curable patients? Journal Article


Authors: Imber, B. S.; Chau, K. W.; Lee, J.; Lee, J.; Casey, D. L.; Yang, J. C.; Wijentunga, N. A.; Shepherd, A.; Hajj, C.; Qi, S.; Chelius, M. R.; Hamlin, P. A.; Lia Palomba, M.; Joffe, E.; Zhang, Z.; Zelenetz, A. D.; Salles, G. A.; Yahalom, J.
Article Title: Excellent response to very-low-dose radiation (4 Gy) for indolent B-cell lymphomas: Is 4 Gy suitable for curable patients?
Abstract: Radiotherapy plays an important role in managing highly radiosensitive, indolent non-Hodgkin lymphomas, such as follicular lymphoma and marginal zone lymphoma. Although the standard of care for localized indolent non-Hodgkin lymphomas remains 24 Gy, de-escalation to very-low-dose radiotherapy (VLDRT) of 4 Gy further reduces toxicities and duration of treatment. Use of VLDRT outside palliative indications remains controversial; however, we hypothesize that it may be sufficient for most lesions. We present the largest single-institution VLDRT experience of adult patients with follicular lymphoma or marginal zone lymphoma treated between 2005 and 2018 (299 lesions; 250 patients) using modern principles including positron emission tomography staging and involved site radiotherapy. Outcomes include best clinical or radiographic response between 1.5 and 6 months after VLDRT and cumulative incidence of local progression (LP) with death as the only competing risk. After VLDRT, the overall response rate was 90% for all treated sites, with 68% achieving complete response (CR). With a median follow-up of 2.4 years, the 2-year cumulative incidence of LP was 25% for the entire cohort and 9% after first-line treatment with VLDRT for potentially curable, localized disease. Lesion size.6 cm was associated with lower odds of attaining a CR and greater risk of LP. There was no suggestion of inferior outcomes for potentially curable lesions. Given the clinical versatility of VLDRT, we propose to implement a novel, incremental, adaptive involved site radiotherapy strategy in which patients will be treated initially with VLDRT, reserving full-dose treatment for those who are unable to attain a CR. © 2021 by The American Society of Hematology.
Journal Title: Blood Advances
Volume: 5
Issue: 20
ISSN: 2473-9529
Publisher: American Society of Hematology  
Date Published: 2021-10-26
Start Page: 4185
End Page: 4197
Language: English
DOI: 10.1182/bloodadvances.2021004939
PROVIDER: scopus
PUBMED: 34529789
PMCID: PMC8945632
DOI/URL:
Notes: Article -- MSK author N. Ari Wijetunga's last name is misspelled on the original publication -- Export Date: 1 December 2021 -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    335 Zhang
  2. Joachim Yahalom
    519 Yahalom
  3. Maria Lia Palomba
    265 Palomba
  4. Andrew D Zelenetz
    672 Zelenetz
  5. Paul Hamlin
    231 Hamlin
  6. Carla Hajj
    73 Hajj
  7. Shunan Qi
    13 Qi
  8. Monica Rose Chelius
    16 Chelius
  9. Karen Chau
    30 Chau
  10. Brandon Stuart Imber
    68 Imber
  11. Erel Joffe
    51 Joffe
  12. Gilles Andre Salles
    55 Salles
  13. Jisun Lee
    6 Lee
  14. Jasme Lee
    16 Lee