TITLE:
Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo
AUTHORS:
Yasser Bayoumi, Aida Radwan
KEYWORDS:
Low Grade Non Hodgkin’s Lymphoma [LG-NHL], Low Dose Total Body Irradiation [LTBI]
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.6 No.1,
December
26,
2014
ABSTRACT: Background and Purpose: The relapsed
low grade non-Hodgkin’s lymphoma (LG-NHL) is currentlyincurable disease and the optimal
treatment regimen has not determined yet. Low dose total body irradiation
(LTBI) provides an alternative mechanism of action against cancer cells rather
than direct cell kill. The mode of action of LTBI is immune-modulatory effect,
induction of apoptosis andhypersensitivity
to low radiation doses. The aim of our study is to evaluate the effect of LTBI
on relapsedLG-NHL and reporting
our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and
Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied
retrospectively.LTBI dose was
1.6 Gy/8 fractions divided on 2 courses; each course 4 fractions treated over 4
days with 2 weeks rest between the 2 courses. Results: The median age is 54
years; 65% of the patients are men. Forty (69%) patients had performance status
of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had
stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm
and 22 (38%) patients had B symptoms at the time of relapse. Theextranodal disease was present in 17
patients (29%) and 78% of the patients received>3 regimens of chemotherapy
before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4
Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved
complete remission (CR) while 45%, 21% and 10% had partial remission (PR),
stable disease (SD) and progressive disease (PD) respectively. The median PFS
duration was 14 months and the median OS durationwas 39 months. Stage VI,>3 regimen of chemotherapy
and bad response to LTBI (SD) affectedprogression
duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is
the only factor affected the OS duration significantly. The 3-year PFS was 19%
± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the
3-year PFS significantly with p value 0.03. The hematological toxicity was the
main side effect of LTBI. Eleven patients developed G3/4 anemia while 8
patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4
leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL
is a feasible, effective and tolerable treatment that is worthy of testing in a
future with chemotherapy and Rituximab maintenance.