title: A high and sustained response rate in refractory or relapsing low-grade lymphoma masses after low-dose radiation: analysis of predictive parameters of response to treatment.
abstract: OBJECTIVE
  To determine the efficacy of small doses of radiation in patients with recurrent or refractory low-grade lymphoma masses.
  
  
  METHODS
  Patients with refractory or relapsing low-grade lymphoma masses. The two largest diameters of the tumor mass were measured, whenever possible, before and after treatment. A dose of 4 Gy of radiotherapy was delivered to tumor sites in 2 fractions. Patients were evaluated for response 1-4 months later and at regular follow-up visits.
  
  
  RESULTS
  Forty-eight patients with low-grade lymphomas according to the working formulation received low-dose radiotherapy between March 1987 and November 1998. Most patients had advanced disease at the time of radiation treatment, and 80% had received at least two chemotherapy regimens before treatment. The median interval between the initial diagnosis and radiotherapy was 2.7 years (range 0-22 years). Low-dose radiation was delivered to 135 tumor sites. Nodal and extranodal tumor sites represented 80% and 20% of masses, respectively. An objective response was obtained in 81% of the sites, with 57% attaining a complete remission. The 2-year actuarial freedom from local progression (FFLP) rate was 56% (95% CI, 46-66%). Tumor masses </=5 cm in diameter had a significantly higher 2-year FFLP rate than larger masses (51% vs. 27%). It is noteworthy that the 2-year FFLP rate for patients treated with less than 2 chemotherapy regimens before radiotherapy was significantly higher than the 2-year FFLP rate for more heavily treated patients (96% vs. 48%). The 2-year FFLP rates for extranodal tumor sites and nodal sites were not significantly different. The tumor size (< or =5 cm vs. > 5 cm), the number of chemotherapy regimens (0-1 vs. more), and age at time of radiation treatment (< or =65 years or > 65 years) were significant predictive parameters of response to treatment.
  
  
  CONCLUSIONS
  In this retrospective study, low-dose radiation proved efficient, with long-lasting effects in the majority of patients with recurrent or refractory low-grade lymphomas. This simple and nontoxic treatment should be investigated prospectively in patients with advanced disease and a low tumor burden not immediately warranting chemotherapy.
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France. girinski@igr.fr
authors.forename: T
authors.initials: T
authors.lastname: Girinsky
authors.forename: D
authors.initials: D
authors.lastname: Guillot-Vals
authors.forename: S
authors.initials: S
authors.lastname: Koscielny
authors.forename: J M
authors.initials: JM
authors.lastname: Cosset
authors.forename: G
authors.initials: G
authors.lastname: Ganem
authors.forename: P
authors.initials: P
authors.lastname: Carde
authors.forename: M
authors.initials: M
authors.lastname: Monhonval
authors.forename: R
authors.initials: R
authors.lastname: Pereira
authors.forename: J
authors.initials: J
authors.lastname: Bosq
authors.forename: V
authors.initials: V
authors.lastname: Ribrag
authors.forename: J M
authors.initials: JM
authors.lastname: Vantelon
authors.forename: J N
authors.initials: JN
authors.lastname: Munck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome