Palliative Single 8 Gy Radiotherapy

for Symptomatic Aggressive

Lymphomas

2666 Ａ -408 　

Oguchi M, Eba J, Tanaka O, Kozuka T, Murofushi K, Toshiyasu T, Tsurugai Y, Onoe T, Nose T, Yamashita T .

Dept. Radiation Oncology. Cancer Institute HospitalThe Japanese Foundation for Cancer Research, Tokyo

Background • Several studies have shown the value

of 4 Gy involved field radiotherapy (IFRT) in recurrent indolent lymphomas.

• Aggressive lymphomas have been initially treated with higher dose of IFRT than indolent lymphomas.

• The palliative radiotherapy for aggressive lymphomas has rarely been documented.

Author Title Journal year

Murthy V Efficacy of palliative low-dose involved field radiation therapy in advanced lymphoma: a phase II study.

Clin Lymphoma & Myeloma

2008

Haas RL Effective palliation by low dose local radiotherapy for recurrent and/or chemotherapy refractory non-follicular lymphoma patients.

Eur J Cancer 2005

Haas RL High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas.

J Clin Oncol 2003

Johannsson J

Phase II study of palliative low-dose local radiotherapy in disseminated indolent non-Hodgkin’s lymphoma and chronic lymphocytic leukemia.

Int J Radiat Oncol Biol Phys

2002

Sawyer EJ Low dose palliative radiotherapy in low grade non-Hodgkin’s lymphoma.

Radiother Oncol

1997

Purpose/Objective

To determine the efficacy and

safety

of single 8 Gy palliative

radiotherapy

for patients with symptomatic

refractory or advanced aggressive

lymphomas.

Materials/Methods:

• This retrospective analysis consists of 75 sites in 28 patients with refractory aggressive lymphomas and impaired PS.

• The 8 Gy single fractionation involved field radiotherapy was administered in each site with appropriate techniques from 2002 to 2008. (PTV = GTV + 1 cm margin)

Patients:

• Their symptoms included pain, discomfort, bulky mass, jaundice and obstruction.

• Median age was 72 years old (range: 40-94). • A median of 3 prior regimens of intensive

chemotherapy were proceeded local palliative radiotherapy.

• The median follow up was 6 months. (range: 3-40)

Pathology n

DLBCL 18

PTCL (AILT) 4 (1)

MCL 2

ALCL 3

NKTL 1

PS(ECOG) n

0 5

1 7

2-3 16

Results: Effectiveness

• Median time to symptomatic progression was 4 months (range: 0-40).

Symptomatic Response

%

CR 41 31/75

PR 48 36/75

SD/PD 11 8/75

89%

Results: Effectiveness

• Median time to progression in tumor size was 4 months (range: 0-40).

Response in Tumor size

%

CR 35 26/73

PR 29 22/73

SD/PD 36 27/73

64%

Results: Toxicity

• Temporary grade 1 acute mucositis was found in 3 sites irradiated to the head & neck mass.

• Retreatment was needed for 5 sites due to their persistent pain.

Case presentation

Pre-XRT Gad-T1 MR

Post-XRT: 7 monthsPET/CT

Conclusions

Palliative radiotherapy of 8 Gy single

fractionation is valuable asset

in the management of patients

with symptomatic refractory or

advanced aggressive lymphomas.

Acknowledgement

Cancer Institute Hospital Dept. Medical Oncology / Hematology

Drs. Hatake, Terui, Yokoyama, etc

Cancer Institute Dept. Pathology

Dr. Takeuchi K.