Radiation therapy for early stage low grade non-hodgkins lymphoma of nodal presentation

Purpose: Radiation therapy is the treatment of choice for early stage low grade non-Hodgkin’s lymphoma (ESLGNHL) of nodal presentation. However, the optimal radiation field is still controversial. We used various radiation fields for this low grade malignancy, and evaluated the results. Materials and methods: Between 1983 and 1993, 14 patients with ESLGNHL were treated with radiation therapy. Five of them received involved field (IF) radiation, 4 regional irradiation (RF), and 5 total lymphoid irradiation (TLI). Results: With a median follow up period of 10 years, 8 of the 14 patients were alive and disease free. Relapse occured in 2 of 5 patients treated with IF, 2 of 4 with RF, and 2 of 5 with TLI. Two patients relapsed following IF had marginal failure, and were salvaged by additional radiation therapy. One patient relapsed following RF had transdiaphragmatic nodal failure, one patient followed TLI relapsed in a non-irradiated area caused by field-matching error. Only one patient with histological transformation into aggressive lymphoma died of disease, and the remaining 5 relapsed patients were alive with or without ESLGNHL. Conclusion: Larger field radiation therapy may reduce nodal and/or marginal failure in patients with ESLGNHL. However without histologic transformation, relapse of ESLGNHL could be salvaged by additional treatment.