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Radiotherapy of extranodal low-grade follicular and marginal zone lymphomas: long-term follow-up of 159 patients

  • Khaled ElsayadEmail author
  • Gabriele Reinartz
  • Michael Oertel
  • Stephan Rehn
  • Jens Eismann
  • Sergiu Scobioala
  • Hendrik Berssenbrügge
  • Nicole Eter
  • Carsten Weishaupt
  • Hartmut H. Schmidt
  • Birte Friedrichs
  • Inga Grünewald
  • Wolfgang Hartmann
  • Georg Lenz
  • Eva Wardelmann
  • Normann Willich
  • Hans Theodor Eich
Original Article

Abstract

Objective

To evaluate clinical, histopathologic, and radiation (RT) dose parameters in patients with extranodal low-grade (ENLG) non-Hodgkin lymphoma (NHL) and their possible impact on local control (LC) and survival.

Materials and methods

The medical records of 159 patients with 181 histologically confirmed ENLG-NHL lesions treated at our institution were reviewed retrospectively.

Results

The predominant histological subtype (73%) was marginal zone lymphoma (MZL). Common lesion sites were the gastrointestinal tract (GIT; 33%), skin (26%), and orbit (21%). The majority of patients (88%) presented with stage I/II disease. Thirty-three (20%) lesions were treated with reduced-dose RT (≤30.6 Gy) and 148 lesions (80%) with conventional-dose RT (>30.6 Gy), with an overall median dose of 39.6 Gy (range 4–63). The median follow-up period was 72 months. The 10-year local control (LC), Progression-free survival (PFS), and overall survival (OS) rates were 96, 65, and 82%, respectively. Higher overall response rate (ORR; 98% vs. 94%, p = 0.001) and complete response rate (CRR; 95% vs. 73%, p = 0.001) were observed in patients treated with conventional-dose regimens than in those treated with reduced-dose regimens. Ten-year PFS (p = 0.90) and OS (p = 0.40) was similar between the two dose groups. RT was well tolerated in both dose groups, with no grade 4/5 toxicities. In the multivariate analysis, RT dose and timing (upfront or salvage) were related to LC, whereas age, histology, and complete response (CR) to RT were associated with PFS. Patient age and radiation field size impacted OS.

Conclusion

RT is an effective and curative local treatment for early-stage FL and MZL at conventional and reduced radiation doses. Conventional-doses seems to be associated with local response improvement, without significant differences in PFS rates. Age, histology, and response to RT may influence the PFS.

Keywords

Gastrointestinal tract Skin Head and neck Orbit Intensity-modulated Involved-site radiotherapy 

Notes

Conflict of interest

K. Elsayad, G. Reinartz, M. Oertel, S. Rehn, J. Eismann, S. Scobioala, H. Berssenbrügge, N. Eter, C. Weishaupt, H.H. Schmidt, B. Friedrichs, I. Grünewald, W. Hartmann, G. Lenz, E. Wardelmann, N. Willich, and H.T. Eich declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Khaled Elsayad
    • 1
    Email author
  • Gabriele Reinartz
    • 1
  • Michael Oertel
    • 1
  • Stephan Rehn
    • 1
  • Jens Eismann
    • 1
  • Sergiu Scobioala
    • 1
  • Hendrik Berssenbrügge
    • 2
  • Nicole Eter
    • 3
  • Carsten Weishaupt
    • 4
  • Hartmut H. Schmidt
    • 5
  • Birte Friedrichs
    • 6
  • Inga Grünewald
    • 7
  • Wolfgang Hartmann
    • 7
  • Georg Lenz
    • 6
  • Eva Wardelmann
    • 7
  • Normann Willich
    • 1
  • Hans Theodor Eich
    • 1
  1. 1.Radiation Oncology DepartmentUniversity Hospital MuensterMuensterGermany
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital MuensterMuensterGermany
  3. 3.Department of OphthalmologyUniversity Hospital MuensterMuensterGermany
  4. 4.Department of DermatologyUniversity Hospital MuensterMuensterGermany
  5. 5.Department of Medicine B for Gastroenterology and HepatologyUniversity Hospital MuensterMuensterGermany
  6. 6.Department of Medicine AUniversity Hospital MuensterMuensterGermany
  7. 7.Gerhard-Domagk-Institute of PathologyUniversity Hospital MuensterMuensterGermany

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