Low dose fractionated whole body irradiation in the treatment of advanced non-Hodgkin's lymphoma

Abstract

Thirty-nine patients with advanced non-Hodgkin's lymphoma (38 patients with lymphocytic lymphoma and 1 patient with mixed lymphocytic and histiocytic lymphoma) were treated by fractionated low dose whole body irradiation (WBI) with a minimum follow-up of 8 months. Twenty-eight patients had no previous treatment and the other 11 patients were in relapse after previous chemotherapy or regional radiotherapy. There were 20 and 19 patients in stages 111 and IV groups, respectively. The majority of patients (31) had nodular histology; diffuse lym'phocytic lymphoma was present in 8 patients (Rappaport criteria) (9). Constitutional symptoms were present in 10 patients. Thirty-three (85%) attained complete remission (CR) with median duration of remission 24 months. Actuarial survival was 78% and 74% at 3 and 4 years. However, relapse free survival was 26% at 3 and 4 years. A prospective randomized trial to compare 10 vs. 15 rad per fraction of fractionated WBI schedules (the same total dose 150 rad) demonstrated no difference in response rate, response duration, and median nadir platelet or WBC counts between the two schedules. Supplement radiotherapy to bulky tumor site revented local recurrence, but did not influence survival or duration of remission. Major toxicity was thrombocytopenia with median nadir platelet counts 77,000/mm3 (1 1,000-170,000/mm3). Five of 6 patients with diffuse lymphocytic poorly differentiated lymphoma attained CR. However, their median survival was 30 months which is much shorter than that of nodular lymphoma. Constitutional symptoms and advanced stage (stage 1V) were associated with shorter duration of remission. Response of patients in relapse after WBI to subsequent chemotherapy f local radiotherapy was CR in 50% and PR in 40%. Fractionated whole body irradiation is an excellent systemic induction agent for advanced lymphocytic and mixed lymphoma.

Induction of interleukin‐1β and interleukin‐6 mRNA by low doses of ionizing radiation in macrophages

“…Fractionated 0.1 to 0.15 Gy TBI has been applied in the clinical treatment of non-Hodgkin's lymphoma [5].…”

Radiobiological Basis for Cancer Therapy by Total or Half-Body Irradiation

“…In a clinical study, Chaffey et al (1976) reported that TBI doses smaller than 25 cGy were effective for lymphosarcoma tumor control, and Choi et al (1979) also reported that it is effective to use low doses of TBI in the treatment of advanced non-Hodgkin's lymphoma. Holder (1965) also recognized that multiple myeloma can be treated successfully by low doses of TBI.…”

Radiobiological Basis of Low-Dose Irradiation in Prevention and Therapy of Cancer

“…[28] The protocols were very similar. The Chaffey, et al 1976 trial used a 150 r LDR course with TBI doses of 15 r 2x/week for 5 weeks.…”

“…The Chaffey, et al 1976 trial used a 150 r LDR course with TBI doses of 15 r 2x/week for 5 weeks. The Choi, et al 1979 trial also used a 150 r LDR course with TBI doses of either 15 r 2x/week or 10 r 3x/week for 5 weeks. In both studies transient low platelets requiring interruption of scheduled therapy occurred in 35-40% of patients, irrespective of 10 r or 15 r dose schedule.…”

“…[26] The 1979 trial shows a similar 74% survival of 39 LDR patients compared with improved 52% survival of 225 patients treated with CHOP ( Figure 13). [28] Sakamoto, et al, Tohoku University, Sendai, Japan, published a 1997 review of their experimental studies in mice and a clinical trial of LDR. In mice, 15 r TBI induced maximal suppression of tumor metastasis ( Figure 9).…”