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J Korean Soc Ther Radiol Oncol > Volume 20(4); 2002 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2002;20(4): 303-308.
The Optimal Radiation Dose in Localized Head and Neck Diffuse Large Cell Lymphoma
Woong Sub Koom, Chang Ok Suh, Yong Bae Kim, Su Jung Shim, Hongryull Pyo, Jae Kyung Roh, Hyun Cheol Chung, Gwi Eon Kim
1Department of Radiation Oncolgy, Yonsei University College of Medicine, Seoul, Korea. cosuh@daum.net
2Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
ABSTRACT
PURPOSE:
To determine the optimal radiation dose in a localized non-Hodgkin's lymphoma of the head and neck in the treatment setting for combined chemoradiotherapy.
MATERIALS AND METHODS:
Fifty-three patients with stage I and II diffuse large cell non-Hodgkin's lymphoma of the head and neck, who were treated with combined chemoradiotherapy between 1985 and 1998 were retrospectively reviewed. The median age was 49 years, and the male-to-female ratio was approximately 1.6. Twenty-seven patients had stage I disease and 26 had stage II. Twenty-three patients had bulky tumors (> or =5 cm) and 30 had non-bulky tumors (<5 cm). The primary tumors arose mainly from an extranodal organ (70%), most cases involving Waldeyer's ring (90%). All patients except one were initially treated with 3~6 cycles of chemotherapy, which was followed by radiotherapy. Radiation was delivered either to the primary tumor area alone (9%) or to the primary tumor area plus the bilateral neck nodes (91%) with a minimum dose of 30 Gy (range 30~60 Gy). The failure patterns according to the radiation field were analyzed, and the relationship between the dose and the in-field recurrence was evaluated.
RESULTS:
The 10-year overall survival and the 10-year disease free survival rates were similar at 75% and 76%, respectively. A complete response (CR) after chemotherapy was achieved in 44 patients (83%). Subsequent radiotherapy showed a CR in all patients. Twelve patients (23%) had a relapse of the lymphoma after the initial treatment. Two of these patients had a recurrence inside the radiation field. No clear dose response relationship was observed and no significant prognostic factors for the in-field recurrences were identified because of the small number of in-field recurrences. However, for patients with tumors <5 cm in diameter, there were no in-field recurrences after a radiation dose 30 Gy. The 2 in-field recurrences encountered occurred in patients with a tumor > or =5 cm.
CONCLUSION:
A dose of 30 Gy is sufficient for local control in patients with a non-bulky (<5 cm), localized, diffuse large cell non-Hodgkin's lymphoma when combined with chemotherapy. An additional boost dose in the primary site is recommended for patients with bulky tumors (> or =5 cm).
Key Words: Localized diffuse large cell lymphoma, Combined chemoradiotherapy, Optimal radiation dose
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