Radiation therapy to the limited disease in patients with early-stage follicular lymphoma “achieves local control in over 90% of lesions, and almost 50% of patients remain free of any lymphoma event (cured) for decades,” Joanna C. Yang, MD, MPH, and Joachim Yahalom, MD, wrote in a recent editorial in the Journal of Clinical Oncology.1 Despite these results and the National Comprehensive Cancer Network® recommendations that patients with early-stage follicular lymphoma receive involved-site radiation therapy,2 most patients do not. Often, the major reason is concern that the standard recommended dose of 24 Gy would be “too toxic,” Dr. Yang told The ASCO Post.
Currently Assistant Professor, Department of Radiation Oncology, University of California, San Francisco, Dr. Yang previously was Chief Resident at Memorial Sloan Kettering Cancer Center and worked collaboratively with coauthor Dr. Yahalom, Attending Radiation Oncologist at Memorial Sloan Kettering Cancer Center and Professor of Radiation Oncology at Weill Cornell Medical College, New York. Dr. Yahalom is also Chair of the International Lymphoma Radiation Oncology Group.
Well-Tolerated Treatment
“What we know from studies is that 24 Gy of radiation is actually well tolerated. We are talking primarily about grade 1 and 2 toxicity. So, the fear of radiation toxicity may largely be based on outdated doses and outdated fields,” Dr. Yang said. With modern involved-site radiation to 24 Gy, the toxicity is low. It is an extremely well-tolerated treatment, even in sensitive areas like the head and neck.”
“Now we are actually giving 4 Gy, 2 days of radiation, and for about 70% of patients, that is all they need,” Dr. Yahalom noted, although it can be repeated if needed. The 4-Gy dose “is effective as a treatment and is sometimes my first choice,” Dr. Yahalom said. “In terms of side effects, it’s nearly like not getting any radiation.”
Shared Treatment Decisions
“It is critically important,” Dr. Yahalom said, that patients be informed of the variety of treatment options available for early-stage follicular lymphoma. This would include hearing from representatives of different treatment modalities, not only a medical oncologist, but a radiation oncologist as well.
It is also important that patients “have all the data,” Dr. Yang said, and understand “the strength of all the data, noting if results are from a small trial, with a small patient population, or a larger trial.” Treatment discussions and decisions, she added, should also consider patient preferences. ■
DISCLOSURE: Drs. Yang and Yahalom reported no conflicts of interest.
REFERENCES
1. Yang JC, Yahalom J: Early-stage follicular lymphoma: What is the preferred treatment strategy? J Clin Oncol 36:2904-2966, 2018.
2. National Comprehensive Cancer Network: B-Cell Lymphomas, version 4.2018. Available at www.nccn.org/professionals/physician_gls/pdf/b-cell_blocks.pdf. Accessed October 5, 2018.
