Management of Localized Low-Grade Follicular Lymphoma

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma. A long natural history and an evolution in staging modalities and treatment options has complicated studies regarding its optimal management. As a result, there is great variety in the therapeutic approaches used for low-grade (grade 1–2) early-stage FL. Definitive radiation therapy (RT) to a generous involved site volume to 24 Gy remains the recommended treatment for patients with stage I or contiguous stage II disease, based on retrospective data demonstrating prolonged disease-free intervals and even cure. An alternative is an even lower-dose RT to 4 Gy, which results in high response rates, with less toxicity but inferior local control. Additionally, observation may be appropriate in selected cases. The use of immunochemotherapy may improve progression-free survival (PFS) when added to RT but does not appear to affect overall survival, so its use in combination with RT or alone remains under investigation. This chapter review focuses on current understanding of these issues in localized grade 1–2 FL.