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2666 A -408. Palliative Single 8 Gy Radiotherapy for Symptomatic Aggressive Lymphomas. Oguchi M, Eba J, Tanaka O, Kozuka T, Murofushi K, Toshiyasu T, Tsurugai Y, Onoe T, Nose T, Yamashita T . Dept. Radiation Oncology. Cancer Institute Hospital - PowerPoint PPT Presentation
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Palliative Single 8 Gy Radiotherapy
for Symptomatic Aggressive
Lymphomas
2666 A -408
Oguchi M, Eba J, Tanaka O, Kozuka T, Murofushi K, Toshiyasu T, Tsurugai Y, Onoe T, Nose T, Yamashita T .
Dept. Radiation Oncology. Cancer Institute HospitalThe Japanese Foundation for Cancer Research, Tokyo
Background • Several studies have shown the value
of 4 Gy involved field radiotherapy (IFRT) in recurrent indolent lymphomas.
• Aggressive lymphomas have been initially treated with higher dose of IFRT than indolent lymphomas.
• The palliative radiotherapy for aggressive lymphomas has rarely been documented.
Author Title Journal year
Murthy V Efficacy of palliative low-dose involved field radiation therapy in advanced lymphoma: a phase II study.
Clin Lymphoma & Myeloma
2008
Haas RL Effective palliation by low dose local radiotherapy for recurrent and/or chemotherapy refractory non-follicular lymphoma patients.
Eur J Cancer 2005
Haas RL High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas.
J Clin Oncol 2003
Johannsson J
Phase II study of palliative low-dose local radiotherapy in disseminated indolent non-Hodgkin’s lymphoma and chronic lymphocytic leukemia.
Int J Radiat Oncol Biol Phys
2002
Sawyer EJ Low dose palliative radiotherapy in low grade non-Hodgkin’s lymphoma.
Radiother Oncol
1997
Purpose/Objective
To determine the efficacy and
safety
of single 8 Gy palliative
radiotherapy
for patients with symptomatic
refractory or advanced aggressive
lymphomas.
Materials/Methods:
• This retrospective analysis consists of 75 sites in 28 patients with refractory aggressive lymphomas and impaired PS.
• The 8 Gy single fractionation involved field radiotherapy was administered in each site with appropriate techniques from 2002 to 2008. (PTV = GTV + 1 cm margin)
Patients:
• Their symptoms included pain, discomfort, bulky mass, jaundice and obstruction.
• Median age was 72 years old (range: 40-94). • A median of 3 prior regimens of intensive
chemotherapy were proceeded local palliative radiotherapy.
• The median follow up was 6 months. (range: 3-40)
Pathology n
DLBCL 18
PTCL (AILT) 4 (1)
MCL 2
ALCL 3
NKTL 1
PS(ECOG) n
0 5
1 7
2-3 16
Results: Effectiveness
• Median time to symptomatic progression was 4 months (range: 0-40).
Symptomatic Response
%
CR 41 31/75
PR 48 36/75
SD/PD 11 8/75
89%
Results: Effectiveness
• Median time to progression in tumor size was 4 months (range: 0-40).
Response in Tumor size
%
CR 35 26/73
PR 29 22/73
SD/PD 36 27/73
64%
Results: Toxicity
• Temporary grade 1 acute mucositis was found in 3 sites irradiated to the head & neck mass.
• Retreatment was needed for 5 sites due to their persistent pain.
Case presentation
Pre-XRT Gad-T1 MR
Post-XRT: 7 monthsPET/CT
Conclusions
Palliative radiotherapy of 8 Gy single
fractionation is valuable asset
in the management of patients
with symptomatic refractory or
advanced aggressive lymphomas.
Acknowledgement
Cancer Institute Hospital Dept. Medical Oncology / Hematology
Drs. Hatake, Terui, Yokoyama, etc
Cancer Institute Dept. Pathology
Dr. Takeuchi K.