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Stellenwert der Strahlentherapie beim disseminierten hochmalignen Non-Hodgkin-Lymphom

Radiotherapy as adjunctive therapy in disseminated high-grade non-Hodgkin’s lymphoma

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Strahlentherapie hat ihren festen Stellenwert in der Behandlung lokalisierter niedrigmaligner Lymphome und neben der Polychemotherapie auch bei lokalisierten hochmalignen Lymphomen. Ihre Integration in die Primärtherapie disseminierter hochmaligner Lymphome wird kontrovers beurteilt.

Patienten und Methodes

Dargestellt werden die Literatur sowie eigene Daten zur Strahlentherapie bei disseminierten hochmalignen Lymphomen.

Ergebnisse

Retrospektive Untersuchungen in Hinblick auf das Rezidivmuster deuten auf den Stellenwert der Stahlentherapie adjuvant zur Polychemotherapie hin, da Rezidive gehäuft in nichtbestrahlten Regionen auftreten. Die Analyse bisher durchgeführter Studien weist auf einen möglichen Vorteil der adjuvanten Strahlentherapie bei Vorliegen von ausgedehnten Tumoren >10 cm (bulky disease) hin. In diesen Fällen gibt es auch Hinweise für eine Dosis-Wirkung-Beziehung. Die wenigen randomisierten Studien haben hingegen keinen sicheren Vorteil einer adjuvanten Strahlentherapie gezeigt, so daß ihr Stellenwert bei disseminierten Lymphomen nicht als gesichert gelten kann. Einen möglichen Vorteil können Patienten haben, die nicht mehr als vier Zyklen einer Polychemotherapie erhielten.

Schlußfolgerung

Retrospektive Untersuchungen deuten auf den Wert der Strahlentherapie adjuvant zur Polychemotherapie auch bei disseminierten hochmalignen Non-Hodgkin-Lymphomen hin. Zu fordern ist eine große kontrollierte Studie, um ihre Wertigkeit randomisiert zu überprüfen.

Abstract

Background

Radiotherapy is part of the treatment protocols in localized low-grade lymphomas as well as localized high-grade lymphomas adjunct to polychemotherapy. Integration of radiotherapy into the treatment of disseminated high-grade lymphomas is controversial.

Patients and Methods

The current literature and our own experience with radiotherapy as part of the treatment of disseminated high-grade lymphomas will be discussed.

Results

Retrospective analysis of large clinical trials suggest the value of radiotherapy in the treatment of disseminated high-grade lymphomas. Relapse occurs more frequently in non-irradiated regions than in fields of prior radiotherapy. Integration of radiotherapy into treatment protocols seems to be beneficial in patients with bulky disease. A dose/response relationship has been described. The few randomized trials, however, could not clearly demonstrate can advantage of radiotherapy adjuvant to chemotherapy in disseminated lymphomas. A possible advantage can be seen in patients who did not receive more than 4 cycles of polychemotherapy.

Conclusion

Although the value of radiotherapy adjunct to ploychemotherapy in disseminated high-grade lymphomas has not been proven in randomized studies retrospective analysis suggest an advantage. A large randomized study should clarify the role of radiotherapy.

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Authors and Affiliations

  1. Abteilung Hämatologie/Onkologie, Zentrum Innere Medizin, Baldinger Straße, D-35033, Marburg

    U. Kaiser & K. Havemann

  2. Abteilung für Strahlentherapie, Zentrum für Radiologie, Klinikum der Philipps-Universität Marburg, Marburg, Deutschland

    R. Pfab

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  1. U. Kaiser
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Kaiser, U., Pfab, R. & Havemann, K. Stellenwert der Strahlentherapie beim disseminierten hochmalignen Non-Hodgkin-Lymphom. Strahlenther. Onkol. 173, 136–140 (1997). https://doi.org/10.1007/BF03039270

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  • DOI: https://doi.org/10.1007/BF03039270

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