Salvage extended-field irradiation in follicular non-Hodgkin's lymphoma after failure of chemotherapy

Purpose: To evaluate the efficacy of total abdominopelvic (TAI) and total body irradiation (TBI) in heavily pretreated follicular non-Hodgkin’s lymphoma (NHL). Patients and Methods: From 1983 to 1998, 34 patients received TAI ( n = 22) or TBI ( n = 12). All had Stage III or IV, Class B, C, D NHL in the working formulation and failed after receiving 1–5 regimens of chemotherapy. TAI was given at 20 Gy over a 3-week period. TBI was delivered in two successive half-body irradiations of 15 Gy over a 2-week period with a 4-week interval between each. Results: Mean follow-up from TAI or TBI was 120 months (range, 6–180). Seventy-six percent of patients achieved complete response and 24% partial response. Median survival was 62 months, 5-year and 10-year overall survival was 59% and 41%, and disease-free survival was 56% and 30%, respectively. Grade III or IV toxicity was gastrointestinal in 38% of patients and hematologic in 30%. No toxic death or delayed complications were observed. Conclusion: Extended-field irradiation is feasible and efficient after failure of chemotherapy in follicular NHL.