title: Outcome of hyperfractionated radiotherapy in chemotherapy-resistant non-Hodgkin's lymphoma.
abstract: OBJECTIVE
  Patients with chemotherapy-resistant lymphoma have rapidly progressive disease and a poor prognosis. Local symptoms are treated with radiotherapy (RT) for local control. We have reviewed local control and toxicity in patients treated with hyperfractionated accelerated RT.
  
  
  METHODS
  A total of 34 patients received hyperfractionated RT between 1997 and 2003. The radiation dose was 39.9-40.5 Gy in 30 fractions. The median treatment time was 22 days with twice-daily involved-field RT. The median follow-up was 4.4 years. Response was assessed <3 months after RT and was classified as a complete response, a complete response-unconfirmed, a partial response, or no response. Local control was defined as maintenance of local complete response, complete response-unconfirmed, or lack of local progression with a partial response. Recurrence or progression outside the RT volume was regarded as distant disease.
  
  
  RESULTS
  The median age was 53 years; 20 patients were men and 14 were women. The initial diagnosis was Stage I-II in 56% and Stage III-IV in 44%. The disease bulk was > or =10 cm in 35% (n = 12). The histologic features at diagnosis were follicular in 11 (Grade 1 in 4, Grade 2 in 3, and Grade 3 in 4), diffuse large B-cell in 14, peripheral T-cell lymphoma in 2, Burkitt-like in 1, mantle cell in 2, natural killer cell in 2, plasmacytoma/lymphoma in 1, and T-cell lymphoblastic in 1. The initial treatment was chemotherapy in 32 patients (94%); 71% were refractory to initial chemotherapy and 29% developed a relapse after an initial response. The RT response was complete in 24% (n = 8), complete, unconfirmed in 26% (n = 9), partial in 47% (n = 16), and none in 3% (n = 1). The local control rate was 73% at 1, 2, and 3 years. Grade 1 dermatitis was the most common side effect.
  
  
  CONCLUSIONS
  Hyperfractionated RT provided good local control and was well tolerated. This encouraging result requires additional study with comparison to conventional fractionation regimens.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Chandra
authors.initials: C
authors.lastname: Martens
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
authors.forename: Woodrow A
authors.initials: WA
authors.lastname: Wells
authors.forename: Alex
authors.initials: A
authors.lastname: Sun
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Melania
authors.initials: M
authors.lastname: Pintilie
authors.forename: Michael
authors.initials: M
authors.lastname: Crump
authors.forename: Mary K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.forename: Richard
authors.initials: R
authors.lastname: Tsang
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D017741:Survivors; D016896:Treatment Outcome