Follicular Lymphoma: Treatment for Early-Stage, Grades 1 and 2, and Advanced-Stage Disease
Follicular lymphoma is the second most common non-Hodgkin lymphoma histology diagnosed and the most common of the indolent histologies. Radiotherapy remains an important treatment modality for patients with follicular lymphoma. Among patients with early-s
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Follicular Lymphoma: Treatment for Early-Stage, Grades 1 and 2, and Advanced-Stage Disease Bradford Hoppe
Abstract
Follicular lymphoma is the second most common non-Hodgkin lymphoma histology diagnosed and the most common of the indolent histologies. Radiotherapy remains an important treatment modality for patients with follicular lymphoma. Among patients with early-stage disease, definitive treatment with radiotherapy remains the standard of care to doses of 24–30 Gy using involved-site radiotherapy. For patients with advanced disease, lowdose radiotherapy (2 Gy/fraction × two fractions) remains an excellent palliative treatment with durable control for approximately 18 months. Utilizing two different clinical scenarios, this chapter discusses epidemiology, staging, and treatment options and provides an in-depth overview of the radiotherapy treatment field design and plan evaluation for follicular lymphoma.
Clinical Presentation
Case 2
Case 1
An 82-year-old female with multiply relapsed stage IV follicular lymphoma (FL) following immunotherapy and chemotherapy presented with a large bulky abdominal mass. In 2014, approximately 70,000 cases of nonHodgkin lymphoma (NHL) were diagnosed in the United States [1]. NHL is made up of about 60 different subtypes, and FL is the second most common (~20 % of all NHL diagnoses); FL is the most common of all indolent histologies. FL generally affects older patients with a median age of 60 years, and it rarely affects children or adolescents [2, 3]. The most common presenting symptom is painless peripheral adenopathy that waxes and wanes in size over time, and B symptoms are found in about 20 % of
A 68-year-old male was seen by his primary care physician for new onset swelling in his right groin. The patient denied any B symptoms, recent trauma, or recent infectious history, and a 4-cm non-painful mass was palpated in the right groin area, movable and not painful.
B. Hoppe, MD, MPH University of Florida Proton Therapy Institute, 2015 North Jefferson St., Jacksonville, FL 32206, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 B.S. Dabaja, A.K. Ng (eds.), Radiation Therapy in Hematologic Malignancies, DOI 10.1007/978-3-319-42615-0_3
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patients. About 80 % of patients are diagnosed with stage III or IV disease [2, 3].
Pathology and Comment on What Is Typical and What Is the Meaning of Markers and Their Implications Case (1). The right groin lymph node demonstrated grade 1 FL with diffuse areas. Immunohistochemical stains revealed CD10-positive, BCL6-positive, and BCL2-positive disease. Case (2). Although a repeat biopsy to confirm that the FL had not developed into a highergrade lymphoma was considered, the patient was not a candidate for additional chemotherapy; furthermore, the biopsy would have been highly invasive for the patient. When NHL is being considered in the differential diagnosis, excisional biopsy of the lymph node is preferred to a core needle biopsy to better evaluate pattern and grade. FL is a B-
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