Phase I study of escalating doses of low-dose-rate, locoregional irradiation preceding Cytoxan-TBI for patients with chemotherapy-resistant non-Hodgkin's or Hodgkin's lymphoma.
OBJECTIVE
In patients in whom bone marrow transplantation (BMT) fails, recurrence often occurs at sites known to have contained disease before initiating BMT. The purpose of this study was to find the maximal tolerable dose of locoregional irradiation (LRT) between 1000 and 2000 cGy that could be integrated with our Cytoxan-total body irradiation (TBI) BMT conditioning regimen in the treatment of lymphoma.


METHODS
Patients had Hodgkin's or non-Hodgkin's lymphoma in chemotherapy-refractory relapse. All patients received LRT to a maximum of three sets of fields encompassing either all current or all previously known sites of disease. Cytoxan-TBI consisted of cyclophosphamide 50 mg/kg daily for 4 days followed by TBI of 1200 cGy given in four fractions.


RESULTS
Twenty-one patients were enrolled. Radiation Therapy Oncology Group Grade 3 in-field acute toxicity was observed in 1 patient at each dose level up to 1500 cGy and in 3 of 6 patients receiving 2000 cGy. Clinically evident late toxicities were limited to hypothyroidism and one second malignancy occurring outside the LRT fields.


CONCLUSIONS
Low-dose-rate, LRT with concurrent Cytoxan-TBI before BMT has acceptable rates of in-field toxicity for doses up to 1500 cGy in five fractions. This regimen safely permits the use of a total combined radiation dose of up to 2700 cGy during 2 weeks, with encouraging in-field response rates in treatment-refractory patients.
Song
D Y
DY
Division of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Oncology Center, Baltimore, MD 21231, USA.
Jones
R J
RJ
Welsh
J S
JS
Haulk
T L
TL
Korman
L T
LT
Noga
S
S
Goodman
S
S
Herman
M
M
Mann
R
R
Marcellus
D
D
Vogelsang
G
G
Ambinder
R F
RF
Abrams
R A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004307:Dose-Response Relationship, Radiation; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects / Q000379:methods*
D003520:Cyclophosphamide