title: Radiotherapy Compared to Other Strategies in the Treatment of Stage I/II Follicular Lymphoma: A Study of 404 Patients with a Median Follow-Up of 15 Years.
abstract: OBJECTIVE
  To investigate outcome for patients with follicular lymphoma (FL) stage I-II treated at a population-based referral institution with a median follow-up of 15 years. Overall and cause-specific survival was compared to that of a sex, age and residency matched individuals from normal population.
  
  
  METHODS
  404 patients with early stage FL treated between 1980 and 2005 were retrospectively analyzed. Two of three patients had stage I disease. Based on clinical characteristics, first line treatments were radiotherapy (RT) (48% of patients), chemotherapy (CT) (16%), combined chemo-and radiotherapy (CRT) (16%) or observation (OBS) (15%). Survival was modeled with Kaplan-Meier methodology. Multivariate analyses were performed with the Cox model.
  
  
  RESULTS
  Fifteen years overall survival (OS), progression free survival (PFS) and time to next treatment (TNT) were 50% (95% confidence interval [CI]: 45-55), 42% (95% CI: 36-47) and 48% (95% CI, 42-54), respectively. For patients treated with RT 97% achieved a complete remission, and 15 year OS, PFS and TNT were 57% (95% CI, 50-64), 46% (95% CI, 39-54) and 49% (95% CI, 42-57), respectively. Relapse rate after RT and CRT was 49% and 36%, respectively. Only 2% of patients who received RT or CRT relapsed inside the radiation field and 5% had isolated near-field relapse. No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer. Compared to a matched normal population, non-lymphoma cancer mortality was higher among patients given RT, hazard ratio 1.66 (95% CI: 1.14-2.42; P<0.01). Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.
  
  
  CONCLUSIONS
  A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients. OBS is a valid initial choice for selected patients without lymphoma-related symptoms.
authors.affiliation: Department of Oncology, Ostfold Hospital Trust, Fredrikstad, Norway.
authors.forename: Dlawer Abdulla
authors.initials: DA
authors.lastname: Barzenje
authors.affiliation: Department of Biostatistics, Oslo University Hospital, Oslo, Norway.
authors.forename: Milada
authors.initials: M
authors.lastname: Cvancarova Småstuen
authors.affiliation: Center for Cancer Biomedicine, University of Oslo, Oslo, Norway; Department of informatics, University of Oslo, Oslo, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Liestøl
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fosså
authors.affiliation: Department of Pathology, Oslo University Hospital, Oslo, Norway.
authors.forename: Jan
authors.initials: J
authors.lastname: Delabie
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Kolstad
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000401:mortality; D059248:Chemoradiotherapy; D002699:Chlorambucil / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008224:Lymphoma, Follicular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D011239:Prednisolone / Q000008:administration & dosage; D012042:Registries; D000069283:Rituximab / Q000008:administration & dosage; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D002699:Chlorambucil; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone