Intensity-modulated Radiotherapy in Patients With Aggressive Extranodal Non-Hodgkin Lymphoma of the Head and Neck

Abstract

Background/Aim: Image-guided intensitymodulated radiotherapy (IG-IMRT) is increasingly being used to treat patients with head and neck malignancies. This analysis compared conventional radiotherapy (CRT) and IMRT outcomes for head and neck aggressive extranodal non-Hodgkin lymphomas (EN-NHL). Patients and Methods: Forty-eight patients who underwent irradiation between 2005 and 2019 were identified. Results: The median followup was 42 months. Patients treated with IMRT experienced higher overall responde rate than patients who received 3DCRT (85% vs. 73%, p=0.4). There was non-significant longer survival following IMRT compared with 3DCRT in terms of . Complete responders after primary treatments had a significantly higher 5-year progression-free (p<0.001) and overall survival (p=0.003) in comparison with those without a complete response. Regarding toxicities, IMRT was associated with less acute and chronic adverse events. Conclusion: IG-IMRT following systemic therapy seems to be associated with a favorable survival and toxicity profile in patients with EN-NHL.Extranodal non-Hodgkin lymphoma (EN-NHL) is defined as lymphoma arising in an extranodal organ or tissue and accounts for approximately one-third of all NHLs (1, 2). The most common localizations for EN-NHL are the gastrointestinal tract, mediastinum, testis, and central nervous system (CNS). The salivary glands, nasal cavity, paranasal sinuses, and thyroid gland are uncommon sites (2).Stage, localization, and histology are essential factors for the decision of treatment modality (2). Radiotherapy (RT) plays a significant role in treating EN-NHL and is frequently used as a consolidation after systemic therapy, salvage treatment, or palliation (1-4). Excellent local control is achieved by RT, resulting in high disease-free and overall survival rates (3). Acute and chronic toxicities of RT are associated with RT dose and rate (1). moreover, irradiated tissue and fraction dose may determine the severity of chronic toxicities (5). Recent dose and volume de-escalation and the increased use of image-guided intensity-modulated radiotherapy (IG-IMRT) in the management of NHL have made it possible to mitigate acute and late toxicities (1-9).The purpose of this analysis was to examine the effects of different RT techniques on locoregional control (LRC) rates and survival in patients with head and neck EN-NHL. Furthermore, radiation toxicities were investigated with regards to radiotherapy techniques.

Clinical Outcomes in Patients With DLBCL Treated With R-CHOP According to Radiotherapy and Interim PET Response

“…In the rituximab era, studies evaluating the role of radiotherapy have produced conflicting results (8)(9)(10), attributed to reduced survival benefits from radiotherapy due to radiation-related toxicity and the heterogeneous nature of DLBCL. Given recent developments in radiotherapy techniques, current treatment strategies employing smaller target volume contours and radiation dose reduction therapy are anticipated to further diminish radiation-related toxicities (11)(12)(13). Therefore, we posit that the incorporation of optimized radiotherapy in selective patients with DLBCL will result in improved clinical outcomes.…”