The role of radiotherapy in the treatment of localised intermediate and high grade non-Hodgkin's lymphoma in elderly patients

Background and purpose: The treatment of elderly patients with high or inte rmediate grade non-Hodgkin's lymphoma (NHL) remains difficult and controver sial. In order to audit our own practice, 270 elderly patients treated betw een 1988 and 1993 with this diagnosis were retrospectively reviewed. Material and methods: 81 patients unfit for chemotherapy received fractiona ted radiotherapy for apparently localised stage I or II disease. The median age of the patients was 78 years (range 70-87 years). Forty stage I and 17 stage II patients had extra-nodal sites of disease. The radiation field in cluded the primary site plus immediate adjacent nodes. Results: After a median follow-up of 3.9 years the 5-year overall and disea se-free survival rates were 33% and 31%, respectively. Age (hazard ratio (H R) 1.22, P = 0.03), stage (HR 5.50, P = 0.02) and lactate dehydrogenase lev el (HR 1.003, P = 0.004) were identified as independent risk factors for re lapse. Conclusion: These factors can define a group in which radiotherapy can prod uce acceptable survival rates (age less than or equal to 80 years, stage I and lactate dehydrogenase less than or equal to 500). This group represente d 34% of those patients where all these variables were recorded and had 5-y ear disease-free and overall survival rates of 56% and 62%, respectively. ( C) 1998 Elsevier Science Ireland Ltd. All rights reserved.