The Optimal Radiation Dose in Localized Head and Neck Diffuse Large Cell Lymphoma.
- Author:
Woong Sub KOOM
1
;
Chang Ok SUH
;
Yong Bae KIM
;
Su Jung SHIM
;
Hongryull PYO
;
Jae Kyung ROH
;
Hyun Cheol CHUNG
;
Gwi Eon KIM
Author Information
1. Department of Radiation Oncolgy, Yonsei University College of Medicine, Seoul, Korea. cosuh@daum.net
- Publication Type:Original Article
- Keywords:
Localized diffuse large cell lymphoma;
Combined chemoradiotherapy;
Optimal radiation dose
- MeSH:
Chemoradiotherapy;
Disease-Free Survival;
Drug Therapy;
Head*;
Humans;
Lymphoma;
Lymphoma, Large B-Cell, Diffuse*;
Lymphoma, Non-Hodgkin;
Neck*;
Radiotherapy;
Recurrence;
Retrospective Studies
- From:The Journal of the Korean Society for Therapeutic Radiology and Oncology
2002;20(4):303-308
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To determine the optimal radiation dose in a localized non-Hodgkin's lymphoma of the head and neck in the treatment setting for combined chemoradiotherapy. MATERIALS AND METHODS: Fifty-three patients with stage I and II diffuse large cell non-Hodgkin's lymphoma of the head and neck, who were treated with combined chemoradiotherapy between 1985 and 1998 were retrospectively reviewed. The median age was 49 years, and the male-to-female ratio was approximately 1.6. Twenty-seven patients had stage I disease and 26 had stage II. Twenty-three patients had bulky tumors (> or =5 cm) and 30 had non-bulky tumors (<5 cm). The primary tumors arose mainly from an extranodal organ (70%), most cases involving Waldeyer's ring (90%). All patients except one were initially treated with 3~6 cycles of chemotherapy, which was followed by radiotherapy. Radiation was delivered either to the primary tumor area alone (9%) or to the primary tumor area plus the bilateral neck nodes (91%) with a minimum dose of 30 Gy (range 30~60 Gy). The failure patterns according to the radiation field were analyzed, and the relationship between the dose and the in-field recurrence was evaluated. RESULTS: The 10-year overall survival and the 10-year disease free survival rates were similar at 75% and 76%, respectively. A complete response (CR) after chemotherapy was achieved in 44 patients (83%). Subsequent radiotherapy showed a CR in all patients. Twelve patients (23%) had a relapse of the lymphoma after the initial treatment. Two of these patients had a recurrence inside the radiation field. No clear dose response relationship was observed and no significant prognostic factors for the in-field recurrences were identified because of the small number of in-field recurrences. However, for patients with tumors <5 cm in diameter, there were no in-field recurrences after a radiation dose 30 Gy. The 2 in-field recurrences encountered occurred in patients with a tumor > or =5 cm. CONCLUSION: A dose of 30 Gy is sufficient for local control in patients with a non-bulky (<5 cm), localized, diffuse large cell non-Hodgkin's lymphoma when combined with chemotherapy. An additional boost dose in the primary site is recommended for patients with bulky tumors (> or =5 cm).
