title: Optimal scheduling to reduce morbidity of involved field radiotherapy with transplantation for lymphomas: a prospective Australasian Leukaemia and Lymphoma Group Study.
abstract: This study evaluated delivery of involved field radiotherapy (IFRT) with transplantation for lymphomas timed to minimise toxicity. Patients transplanted for lymphoma had infradiaphragmatic disease irradiated pre-transplant and supradiaphragmatic disease post transplant. A total of 31 patients were studied, with a median follow-up duration of 4 years. Transplant conditioning was according to clinician preference. In all, 14 patients had pre-transplant abdominopelvic IFRT and 19 had post transplant IFRT (including three who had pre-transplant IFRT). Grade III-IV haematological toxicity from pre-transplant IFRT occurred in three patients and from post transplant IFRT in 10 patients. Pre-transplant IFRT had no effect on haematological recovery post transplant, but was associated with a trend towards increased gastrointestinal toxicity (P = 0.094). Pneumonitis due to post transplant thoracic IFRT occurred in one patient. Two patients failed in involved sites after completion of protocol radiotherapy. One case of myelodysplasia has been reported. As sequenced in this study, IFRT was feasible and produced a low incidence of severe pulmonary and haematological toxicities. Patient selection, field size and radiotherapy dose warrant further study.
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia. andrew.wirth@petermac.org
authors.forename: A
authors.initials: A
authors.lastname: Wirth
authors.forename: H M
authors.initials: HM
authors.lastname: Prince
authors.forename: M
authors.initials: M
authors.lastname: Wolf
authors.forename: J M
authors.initials: JM
authors.lastname: Stone
authors.forename: J
authors.initials: J
authors.lastname: Matthews
authors.forename: J
authors.initials: J
authors.lastname: Gibson
authors.forename: C
authors.initials: C
authors.lastname: Macleod
authors.forename: J
authors.initials: J
authors.lastname: Szer
authors.forename: A
authors.initials: A
authors.lastname: Grigg
authors.forename: B
authors.initials: B
authors.lastname: To
authors.forename: D
authors.initials: D
authors.lastname: Roos
authors.forename: A P
authors.initials: AP
authors.lastname: Schwarer
authors.forename: S
authors.initials: S
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D003131:Combined Modality Therapy; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008223:Lymphoma / Q000150:complications / Q000532:radiotherapy* / Q000628:therapy; D008875:Middle Aged; D010865:Pilot Projects; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D017211:Treatment Failure