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[deleted4401]

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Does anybody or has anybody done the 2 x 2 Gy palliation for follicular/low grade lymphoma palliation? Do you have size limit or any size? I just had the opportunity to see one in consultation, but I can't wrap my head around 4 Gy being enough for this 7 x 6 cm mass in the inguinal region.
-S

 

[Gfunk6]

I've seen it a couple of times in residency. I was incredulous at first and it really surprised me that they melt REALLY fast. Also can repeat in a few months as needed.

 

[Brim]

 

[iradi8u]

I've used it once to a rather large field - pelvic and inguinal nodes bilaterally for low grade lymphoma causing significant pain from leg edema. Helped some, not a lot. I've just added fractions to hopefully actually give this patient some durable palliation. A co-resident used 2x2 to a smaller field with good results.

 

[TarHeelRadOnc]

I've used it once to a rather large field - pelvic and inguinal nodes bilaterally for low grade lymphoma causing significant pain from leg edema. Helped some, not a lot. I've just added fractions to hopefully actually give this patient some durable palliation. A co-resident used 2x2 to a smaller field with good results.

Used several times in residency and in community practice. Had great results. In Haas JCO study, 44% had tumors/nodes >5cm and reported >90% response rate... so it works in larger tumors. Would be hesitant to use in lesions >10cm. Despite a high rate of lymphoma apoptosis within the first 24 hours, some patience is required. The magnitude of response is often not appreciated until first follow up 1 month later.

 

[Palex80]

I treated a patient with 2x2 Gy for a 12 cm long and about 5 cm wide mass in his right arm muscles. Histology showed marginal zone lymphoma. Treatment was in January. I saw the patient for follow up 2 weeks ago and the mass had disappeared. There still was a slight swelling of the right arm, but it was all soft.

 

[alphacentauri]

I did it a ton in residency - basically every palliative follicular lymphoma case that came through the door got 2 Gy x2 (as well as occasional low grade lymphomas of other histologies - disseminated MALT, etc). It usually works really well. And, if it doesn't work, you can always re-treat to a higher dose since they've only received 4 Gy. Just make sure the patient understands that it may take a little while to get a response. If it's causing the patient a lot of pain, or threatening any adjacent organs you probably want to go higher to get a quick response though.

 

[ShirleyT]

Yes, I've also used it a few times, but agree that it can take a while. the last case I did was a periorbital mass that was and I did not want to cause a dry eye but it took about 3 months for it to completely go away.