ALTERNATING CHEMOTHERAPY AND RADIOTHERAPY FOR LIMITED-STAGE INTERMEDIATE AND HIGH-GRADE NON-HODGKINS-LYMPHOMAS - LONG-TERM RESULTS FOR 96 PATIENTS WITH TUMORS GREATER-THAN-5 CM

Background: The role and timing of radiotherapy for optimal treatment of localized aggressive non-Hodgkin's lymphoma (NHL) is controversial. We report the long-term results of a single-institution pilot study o f alternating chemotherapy (CT) and radiotherapy (RT) in patients with clinical stages I or II tumors exceeding 5 cm. Patients and methods: From 1981 to 1992, 96 patients with stages I-II aggressive NHL receive d an alternating regimen of CT and RT consisting of 8 cycles of CT wit h 3 courses of RT interjected after the 2nd, 3rd and 4th cycles of CT. The CT combined cyclophosphamide, doxorubicin, teniposide and prednis one every 28 days. Each RT course was started 8 to 10 days after CT (1 5 Gy in 6 fractions to initially involved and contiguous areas). Resul ts: The median age was 54 years. The disease predominantly located in the head and neck area was stage II in 63% of patients. Bulky tumors ( 10 cm or larger) were found in 24% of patients. Six patients discontin ued CT because of acute toxicity (mucositis). The mean relative dose i ntensity achieved for doxorubicin, cyclophosphamide and teniposide wer e 72%, 82%, and 78%, respectively. Late toxicity consisted mostly of s evere xerostomia lasting more than 2 years in 7 patients irradiated in Waldeyer's ring. The complete response (CR) rate was 91%; 20 of the 8 6 patients in CR relapsed (3 locally only). The median follow-up was 6 1 months, and at 5 years, overall survival (OS) was 77%. Classificatio n according to the International Prognostic Factor Index was possible for 54 patients, all but three of whom were in the 'low risk' group (0 -1 factor). Bulky disease was the only unfavorable prognostic factor ( P < 0.001) for CR, freedom from progression (FFP) and OS rates; the lo w relative dose intensity of CT achieved in this study did not affect outcome. Conclusion: Alternating chemo-radiotherapy for localized aggr essive NHL was feasible and yielded long-term results comparable to th ose obtained with standard treatments, despite a reduction in dose int ensity considerably below that of CHOP which suggested synergistic eff ects of CT and RT in this scheme.