Clinicians should use radiotherapy very judiciously in the treatment of mediastinal lymphomas, especially in young patients, recommended Wyndham H. Wilson, MD, PhD, Chief of the Hematological Malignancies Therapeutics Section, Metabolism Branch, Cancer Research Center, of the National Cancer Institute in Bethesda, Maryland., Moreover, longer-term data suggest the prognosis of mediastinal gray zone lymphomas may not be as poor as previously thought in the absence of radiotherapy, he said at the Pan Pacific Lymphoma Conference held in Kohala Coast, Hawaii.

Who Needs Radiotherapy?

“It still stands that they have a significantly worse outcome than that associated with primary mediastinal lymphoma. We still watch them very carefully, and we find that if the Deauville score is 1, 2, or 3, that those people almost never relapse, but if it’s more than that, then radiation is needed,” he said.

“I think it is an open question whether or not you want to give all of these patients radiotherapy. I would agree that they do the worst, and if you really want to be extra cautious, then you certainly could radiate them all,” he continued. “But as it turns out, the Deauville score is a pretty good way of identifying those with gray zone lymphoma who really need radiation.”

Recent long-term data on patients receiving radiotherapy for Hodgkin lymphoma are “devastating,” Dr. Wilson maintained. “I just wanted to emphasize that radiotherapy in young people is dangerous, dangerous, dangerous. And if there is anything you can do to not use it, I think that would be really wise,” he concluded. ■

 Disclosure: Dr. Wilson reported no potential conflicts of interest.