PLACE OF LOW-DOSE TOTAL-BODY IRRADIATION IN THE TREATMENT OF LOCALIZED FOLLICULAR NON-HODGKINS-LYMPHOMA - RESULTS OF A PILOT-STUDY

Purpose: In a first prospective nonrandomized trial, 107 patients with Stage LII and IV ''low-grade'' lymphomas have been treated with a com bination of chemotherapy and low-dose total body irradiation (LD-TBI), This study shows that this scheme of LD-TBI was very well tolerated, gave a high response rate (83%), and extended RFS, It incited us to st art a pilot study on localized follicular lymphomas, Methods and Mater ials: From January 1986 through October 1994, 34 patients with previou sly untreated localized low-grade nonHodgkin's lymphomas have been inc luded in a prospective trial with LD-TBI followed by radical involved field radiotherapy (UF-RT), Patients received two courses of whole bod y irradiation of 0.75 Gy in 5 fractions and 1 week separated by a rest period of 2 weeks, After 1 month, patients were reevaluated, and rece ived 40 Gy in 20 fractions, and 4 weeks on initially pathological lymp h node areas, Eight patients have been excluded from the study: 4 afte r histologic review (2 centrocytic, 1 lymphocytic, 1 centroblastic) an d 4 patients with Stage IV because of bone-marrow involvement. The rem aining 26 patients were 11 men and 15 women, 50 years old median age ( mean: 50.2; range: 35-73.5) with clinical Stage I (10 pts), II1 (8 pts ), and II2 (8 pts), All patients received the planned treatment, Resul ts: Clinical tolerance was excellent, and the hematological follow-up shows a mean nadir value of 3.9.10(9)/I (2.1-8.1) for leucocytes, 13.4 g/l (10.8-15.4) for hemoglobin, and 124.10(9)/I (46-216) for platelet s, with a median delay of 3.2 months, Of 26 patients, 24 achieved comp lete remission (CR) after the LD-TBI that was before the IF-PT, All pa tients, except one, were in complete remission after IF-RT, Nineteen p atients remain alive without any evidence of disease, with a median fo llow-up of 56.2 months, Five patients relapsed; 3 of them died, Conclu sion: As delivered, this schedule of LD-TBI give a very high rate of C R in localized follicular non-Hodgkin's lymphoma, with a very good tol erance. It remains to prove that this immediate efficacy has an impact Hodgkin on long-term disease-free survival in such patients, and to u nderstand how the LD-TBI works (direct and/or indirect induction of ap optosis; relationship with t(14;18) translocation and overexpression o f bcl-2), These will be the two aims of a new EORTC prospective random ized trial comparing LD-TBI followed by IF-PT vs, IF-RT alone. (C) 199 8 Elsevier Science Inc.