Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

Abstract

Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT.

Curative radiation for orbital MZL: how much?

“…6 This experience is supported by several studies documenting excellent control with this dose range. 7 Some suggest that conjunctival lesions are controlled with the lower dose range, whereas for deeper lesions 30 Gy will suffice.…”

Primary Thyroid Lymphoma : An Uncommon Etiology of Compressive Goiter

“…Radiotherapy could be used as an adjuvant treatment to prior surgery or chemotherapy, treating potential microscopic residual disease. The decision of using it should take in consideration initial tumor bulk, response to systemic therapy and the morbidity of irradiation (19) . This therapeutic modality may also be used as salvage therapy for localized recurrences after surgery or chemotherapy (19) .…”

“…The decision of using it should take in consideration initial tumor bulk, response to systemic therapy and the morbidity of irradiation (19) . This therapeutic modality may also be used as salvage therapy for localized recurrences after surgery or chemotherapy (19) . Excellent control can be achieved using low doses 30 Gy which mostly played in the regimen « extended field radiotherapy » including the mediastinal nodes and sometimes the axillary lymph nodes (12) .…”

Saturday 21 October 2017

“…Focal marrow involvement is seen as increased 18 FDG-uptake with reduced T1 and increased STIR signal. Marrow reconversion during therapy is associated with diffusely increased 18 FDG-uptake but with signal drop-out on opposed-phase Dixon images due to the approximately equal fractions of fat and water within red marrow.…”

“…Focal marrow involvement is seen as increased 18 FDG-uptake with reduced T1 and increased STIR signal. Marrow reconversion during therapy is associated with diffusely increased 18 FDG-uptake but with signal drop-out on opposed-phase Dixon images due to the approximately equal fractions of fat and water within red marrow. Marrow reconversion can therefore be distinguished from residual disease which shows increased 18 FDG-avidity without signal drop-out on opposed-phase imaging.…”