Skip to main content

Advertisement

SpringerLink
Log in

Long-Term Outcome and Prognostic Factors in Early-Stage Nodal Low-Grade Non-Hodgkin’s Lymphomas Treated with Radiation Therapy

Behandlungsergebnisse und prognostische Faktoren nach Radiotherapie niedrigmaligner nodaler Non-Hodgkin-Lymphome in frühen Stadien

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Purpose:

Retrospective analysis of therapy results in patients with stage I–II and limited stage III nodal low-grade non-Hodgkin’s lymphoma (NHL).

Patients and Methods:

The present retrospective study covers 65 patients treated between 1988 and 2006 at the Department of Radiation Oncology, University of Cologne, Germany. 50 patients were treated with radiotherapy alone (EF [extended field]: n = 35, IF/REG [involved field/regional field]: n = 9, TNI/TLI [total nodal/total lymphatic]: n = 6), 15 patients additionally received chemotherapy. Median age was 58 years. 58 patients presented with centroblastic-centrocytic or follicular lymphomas, seven patients had centrocytic lymphomas. Apart from overall and relapse-free survival, relapse patterns were examined and the impacts of patient characteristics and therapy modalities were analyzed.

Results:

After a median follow-up of 9.1 years, overall 5-year and 10-year survival was 86% and 55%, relapse-free survival was 55% and 37%, respectively. Relapses occurred in 28 patients during the observation period. Overall survival was favorably influenced by low patient age (p = 0.037), centroblastic-centrocytic/follicular histology (p = 0.006), and early disease stage (p = 0.045). Favorable prognostic factors for relapse-free survival were low patient age (p = 0.035) and centroblastic-centrocytic/follicular histology (p = 0.001).

Conclusion:

Radiotherapy of early-stage low-grade NHL is a curative therapy option, particularly in younger patients and patients with follicular histology. Relapse analysis confirmed the benefits of total nodal or total lymphatic irradiation, although the small number of patients needs to be considered.

Ziel:

Retrospektive Auswertung der Behandlungsergebnisse bei Patienten mit niedrigmalignen nodalen Non-Hodgkin-Lymphomen (NHL) im Stadium I–II und im limitierten Stadium III.

Patienten und Methodik:

Die vorliegende retrospektive Studie umfasst 65 Patienten, die zwischen 1988 und 2006 in der Klinik und Poliklinik für Strahlentherapie der Universitäat zu Köln behandelt wurden. 50 Patienten erhielten eine alleinige Radiotherapie (EF [„extended field“]: n = 35, IF/REG [„involved field“]: n = 9, TNI/TLI [„total nodal/total lymphatic“]: n = 6), 15 Patienten zusätzlich eine Chemotherapie. Das mediane Alter betrug 58 Jahre. Bei 58 Patienten handelte es sich um ein zentroblastisch-zentrozytisches bzw. follikuläres Lymphom, bei sieben Patienten um ein zentrozytisches Lymphom. Neben Gesamtüberleben und rezidivfreiem Überleben wurden das Rezidivmuster untersucht und der prognostische Einfluss von Patientencharakteristika und Therapiemodalitäten analysiert.

Ergebnisse:

Bei einer medianen Nachbeobachtungszeit von 9,1 Jahren betrug das 5- bzw. 10-Jahres-Gesamtüberleben aller Patienten 86% und 55%, das rezidivfreie Überleben 55% und 37%. Bei 28 Patienten kam es im Verlauf zum Auftreten eines Rezidivs. Prognostisch günstigen Einfluss auf das Gesamtüberleben hatten niedriges Patientenalter (p = 0,037), zentroblastisch-zentrozytische/follikuläre Histologie (p = 0,006) und frühes Erkrankungsstadium (p = 0,045). Fur das rezidivfreie Überleben zeigten sich ebenfalls das jungere Alter (p = 0,035) und die zentroblastisch-zentrozytische/follikuläre Histologie (p = 0,001) als günstige Prognosefaktoren.

Schlussfolgerung:

Die Radiotherapie niedrigmaligner NHL in frühen Stadien ist eine kurative Therapieoption, insbesondere bei jungeren Patienten und follikulärer Histologie. In der Rezidivanalyse erwies sich die totale nodale bzw. totale lymphatische Bestrahlung als vorteilhaft, zu berücksichtigen ist jedoch die geringe Patientenzahl.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Besa PC, McLaughlin PW, Cox JD, et al. Long term assessment of patterns of treatment failure and survival in patients with stage I or II follicular lymphoma. Cancer 1995;75:2361–7.

    Article  PubMed  CAS  Google Scholar 

  2. Bischof M, Karagiozidis M, Krempien R, et al. Radiotherapy for orbital lymphoma. Outcome and late effects. Strahlenther Onkol 2007; 183:17–22.

    Article  PubMed  Google Scholar 

  3. Carbone PP, Kaplan HS, Musshoff K, et al. Report of the Committee on Hodgkin’s Disease staging classification. Cancer Res 1971;31:1860–1.

    PubMed  CAS  Google Scholar 

  4. Chapuy B, Borchmann P, Engert A, et al. Targeted-Therapie. Neue Zielstrukturen und Substanzen in der Behandlung maligner Lymphome. Onkologe 2006;12:651–8.

    Article  Google Scholar 

  5. Cox DR. Regression models and life tables (with discussion). J R Stat Soc 1972;B34:187–202.

    Google Scholar 

  6. Denham JW, Denham E, Dear KB, et al. The follicular non-Hodgkin’s lymphomas — I. The possibility of cure. Eur J Cancer 1996;32A:470–9.

    Article  PubMed  CAS  Google Scholar 

  7. Dreyling M, Schmidberger H, Hiddemann W. Aktuelle Therapieoptionen des indolenten Lymphoms. Onkologe 2006;12:612–8.

    Article  Google Scholar 

  8. Engelhard M, Allgäuer M, Amela-Neuschwander S, et al. Follicular lymphoma, immunocytoma, and mantle cell lymphoma: randomized evaluation of curative radiotherapy in limited stage nodal disease. Strahlenther Onkol 2007;183:Special Issue 1:129.

    Google Scholar 

  9. Engelhard M, Allgäuer M, Bamberg M, et al. Follicular lymphoma, immunocytoma, and mantle cell lymphoma: prospective evaluation of curative radiotherapy in limited stage nodal disease. Strahlenther Onkol 2006;182: Special Issue 1:17.

    Google Scholar 

  10. Engelhard M, Stuschke M. Non-Hodgkin-Lymphome. In: Bamberg M, Molls M, Sack H, Hrsg. Radioonkologie 2. Klinik. München-Wien-NewYork: Zuckschwerdt, 2004:1052–97.

    Google Scholar 

  11. Epelbaum R, Kuten A, Coachman NM, et al. Stage I-II low grade non-Hodgkin’s lymphoma: prognostic factors and treatment results. Strahlenther Onkol 1992;162:66–72.

    Google Scholar 

  12. Frank C, Zierhut D, Schulz-Ertner D, et al. Centroblastic-centrocytic non-Hodgkin’s lymphoma stage I–III: patterns of failure following radiotherapy. Strahlenther Onkol 2001;177:597–603.

    Article  PubMed  CAS  Google Scholar 

  13. Guadagnolo BA, Li S, Neuberg D, et al. Long-term outcome and mortality trends in early-stage, grade 1-2 follicular lymphoma treated with radiation therapy. Int J Radiat Oncol Biol Phys 2006;64:928–34.

    PubMed  Google Scholar 

  14. Haidenberger A, Popper BA, Ginestet A, et al. Kombinierte Radio/Immuntherapie mit MabThera (Rituximab) bei Non-Hodgkin-Lymphomen — Pilotstudie. Strahlenther Onkol 2006;182:Sondernr 1:17.

    Google Scholar 

  15. Heinzelmann F, Lang PJ, Ottinger H, et al. TLI (total lymphoid irradiation/total lymphatische Bestrahlung) basierte Rekonditionierung ermöglicht engraftment und Langzeitüberleben nach Transplantatversagen bei Patienten mit hämatologischen Systemerkrankungen. Strahlenther Onkol 2007;183: Sondernr 1:130.

    Google Scholar 

  16. Kamath SS, Marcus RB, Lynch JW, et al. The impact of radiotherapy dose and other treatment-related and clinical factors on in-field control in stage I and II non-Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys 1999;44: 563–8.

    Article  PubMed  CAS  Google Scholar 

  17. Kaplan EL, Meier P. Nonparametric estimations from incomplete observations. J Am Stat Assoc 1958;53:457–81.

    Article  Google Scholar 

  18. Kelsey SM, Newland AC, Vaughan Hudson G, et al. A British National Lymphoma Investigation randomized trial of single agent chlorambucil plus radiotherapy versus radiotherapy alone in low grade, localised non-Hodgkin’s lymphoma. Med Oncol 1994;11:19–25.

    Article  PubMed  CAS  Google Scholar 

  19. Lawrence TS, Urba WJ, Steinberg SM, et al. Retrospective analysis of stage I and II indolent lymphomas at the National Cancer Institute. Int J Radiat Oncol Biol Phys 1988;14:417–24.

    PubMed  CAS  Google Scholar 

  20. Leitch HA, Gascoyne RD, Chhanabhai M, et al. Limited stage mantle cell lymphoma: clinical outcome in patients from British Columbia. Blood 2001;98:342a.abstract 1443.

    Google Scholar 

  21. MacManus MP, Hoppe RT. Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University. J Clin Oncol 1996;14:1282–90.

    CAS  Google Scholar 

  22. Mauch P. Follicular non-Hodgkin’s lymphoma: the role of radiation therapie. Ann Hematol 2001;80:6–65.

    Google Scholar 

  23. McLaughlin P, Fuller LM, Velasquez WS, et al. Stage I-II follicular lymphoma. Cancer 1986;58:1596–602.

    Article  PubMed  CAS  Google Scholar 

  24. MIR-Studie (MabThera und Involved-field Radiotherapie). Therapie des nodalen follikulären Non-Hodgkin-Lymphoms (WHO Grad I/II) im klinischen Stadium I/II mittels involved-field Bestrahlung in Kombination mit Rituximab. ARO 2007-2.

  25. Monfardini S, Banfi A, Bonadonna G, et al. Improved five year survival after combined radiotherapy-chemotherapy for stage I-II non-Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys 1980;6:125–34.

    PubMed  CAS  Google Scholar 

  26. Murtha AD, Knox SJ, Hoppe RT, et al. Long-term follow-up of patients with stage III follicular lymphoma treated with primary radiotherapy at Stanford University. Int J Radiat Oncol Biol Phys 2001;49:3–15.

    PubMed  CAS  Google Scholar 

  27. Neumann H, Blanck H, Koch R, et al. Behandlungsergebnisse beim follikulären Keimzentrumslymphom Stadium I und II. Strahlenther Onkol 2003;179:840–6.

    Article  PubMed  Google Scholar 

  28. Nevinny-Stickel M, Poljanc K, Forthuber BC, et al. Optimized conformal paraaortic lymph node irradiation is not associated with enhanced renal toxicity. Strahlenther Onkol 2007;183:385–91.

    Article  PubMed  Google Scholar 

  29. Nickening C, Dreyling M, Nerl C, et al. Follikuläre und andere indolente Lymphome. Manual Maligne Lymphome. München: Tumorzentrum, Zuckschwerdt, 2004:97–107.

    Google Scholar 

  30. Nissen NN, Ersboll J, Hansen HS, et al. A randomized study of radiotherapy versus radiotherapy plus chemotherapy in stage I–II non-Hodgkin’s lymphomas. Cancer 1983;52:1–7.

    Article  PubMed  CAS  Google Scholar 

  31. Ott OJ, Rödel C, Gramatzki M, et al. Radiotherapy for stage I–III nodal low grade non-Hodgkin’s lymphoma. Strahlenther Onkol 2003;179:694–701.

    Article  PubMed  Google Scholar 

  32. Paryani SB, Hoppe RT, Cox RS, et al. Analysis of non-Hodgkin’s lymphomas with nodular and favorable histologies, stages I and II. Cancer 1983;52:2300–7.

    Article  PubMed  CAS  Google Scholar 

  33. Pendlebury S, El Awadi M, Ashley S, et al. Radiotherapy results in early stage low grade nodal non-Hodgkin’s lymphoma. Radiother Oncol 1995;36:167–71.

    Article  PubMed  CAS  Google Scholar 

  34. Petersen PM, Gospodarowicz M, Tsang R, et al. Long-term outcome in stage I and II follicular lymphoma following treatment with involved field radiation therapy alone. J Clin Oncol 2004;22:Suppl:563s.abstract.

  35. Roth J, Martinez AE. Determination of organ doses and effective doses in radiooncology. Strahlenther Onkol 2007;183:392–7.

    Article  PubMed  Google Scholar 

  36. Sack H, Hoederath A, Stuschke M, et al. Strahlenbehandlung von follikulären Keimzentrumslymphomen. Ergebnisse einer deutschen multizentrischen und prospektiven Studie. Strahlenther Onkol 1998;174:178–85.

    Article  PubMed  CAS  Google Scholar 

  37. Schneider RA, Schultze J, Jensen JM, et al. 20 years of experience in static intensity-modulated total-body irradiation and lung toxicity. Results in 257 consecutive patients. Strahlenther Onkol 2007;183:545–51.

    Article  PubMed  Google Scholar 

  38. Schneider U, Lomax A, Pemler P, et al. The impact of IMRT and proton radiotherapy on secondary cancer incidence. Strahlenther Onkol 2006;182: 647–52.

    Article  PubMed  Google Scholar 

  39. Soubeyran P, Eghbali H, Bonichon F, et al. Localized follicular lymphomas: prognosis and survival of stages I and II in a retrospective series of 103 patients. Radiother Oncol 1988;13:91–8.

    Article  PubMed  CAS  Google Scholar 

  40. Taylor RE, Allan SG, McIntyre MA, et al. Low grade stage I and II non-Hodgkin’s lymphoma: results of treatment and relapse pattern following therapy. Clin Radiol 1988;39:287–90.

    PubMed  CAS  Google Scholar 

  41. Therapie der niedrigmalignen nodalen Non-Hodgkin Lymphome in frühen Stadien mit alleiniger Radiotherapie, ARO Reg. Nr. 1/98 Deutsche Krebshilfe 70-2317-Sa 13, 2. Aufl.

  42. Vaughan Hudson B, Vaughan Hudson G, Maclennan KA, et al. Clinical stage I non-Hodgkin’s lymphoma: long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy. Br J Cancer 1994; 69:1088–93.

    PubMed  CAS  Google Scholar 

  43. Yahalom J, Varsos G, Fuks Z, et al. Adjuvant cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy after radiation therapy in stage I low-grade and intermediate-grade non-Hodgkin lymphoma. Cancer 1993;71:2342–50.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Cologne, Köln, Germany

    Hans Theodor Eich, Martina Heimann, Jan Kriz & Rolf-Peter Müller

  2. Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne, Köln, Germany

    Hartmut Stützer

  3. Clinic I for Internal Medicine, University of Cologne, Köln, Germany

    Marcel Reiser

  4. Department of Radiation Oncology, University of Cologne, Kerpener Straße 62, 50937, Köln, Germany

    Hans Theodor Eich

Authors
  1. Hans Theodor Eich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martina Heimann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hartmut Stützer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Kriz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcel Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rolf-Peter Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans Theodor Eich.

Additional information

Presented at the 14th Annual Meeting of the German Society for Therapeutic Radiology and Oncology (DEGRO), Vienna, May 1–4, 2008.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eich, H.T., Heimann, M., Stützer, H. et al. Long-Term Outcome and Prognostic Factors in Early-Stage Nodal Low-Grade Non-Hodgkin’s Lymphomas Treated with Radiation Therapy. Strahlenther Onkol 185, 288–295 (2009). https://doi.org/10.1007/s00066-009-1937-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-009-1937-4

Key Words:

Schlüsselwörter:

Search

Navigation