Radiotherapy for stage I/II follicular lymphoma (FL): is it time for a re-appraisal?

Aim: Almost 30% of follicular lymphomas (FL) present with stage I-II disease. Although the standard-of-care consists of involved-field radiotherapy (IFRT), approximately half of patients relapse usually outside the primary irradiation field. Systemic immunotherapy with rituximab (R), with or without IFRT, could reduce distant recurrences leading to a better outcome. Therefore, we compared the efficacy of IFRT-alone or associated with R (R+IFRT) versus R-alone in stage I/II FL (grade 1-3A).

Patients And Methods: From 1995 to September 2012, 108 early-stage FL patients were retrospectively assessed: 36 underwent IFRT, 38 R-alone and 34 R+IFRT.

Results: Complete response rate was 84% in the IFRT-group, 87% in the R group and 97% in the R+IFRT-group. Median progression-free survival and time to next treatment were significantly higher in both rituximab arms compared to IFRT-alone.

Conclusion: R or R+IFRT have demonstrated a better long-term control of the disease without significant additional toxicities.