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Hello everybody.
I treated a 40 year old male 1,5 years ago with a stage I A follicular lymhoma G2 in the left groin. The patient received 30 Gy IF-RT (inguinal & external iliac lymph nodes), followed by a boost to a total of 36 Gy at the left groin. The mass on the left groin was gone after radiation therapy, he tolerated the treatment quite well.
He has now developed a new enlarged lymph node at the right groin, biopsy showed follicular lymphoma again. FDG-PET-CT shows, that this is the only disease currently present.
He was referred by the medical oncologists for treatment and I am gonna treat him.
Questions:
1. I pondered, if I should give him 2x2 Gy, since its a recurrence and probably palliative treatment. While I was reviewing the plan of the last treatment, I saw that we actually did a 4 field box for the other side, thus around 20% of the dose had partially covered the now involved site back then. If microscopic disease was present in the left groin (but undetected by the initial FDG-PET-CT) back then, 20% of 30 Gy = 6 Gy (given over 3 weeks), may have been enough to kill it, if the tumor was highly radiation sensitive. They obviously failed to do so, so I don't think 2x2 Gy are gonna work. Furthermore he's young and despite having a recurrence, he still has a lot of treatment options left. So maybe I should treat him aggressively?
2. I pondered about the volume to irradiate. I did IF-RT back then for the left side, but the lymphoma crossed to the other side.
Would it make sense to go for EF-RT and treat right groin, complete right iliac region, upper iliac left region and paraaortal too (thus practically leaving out only the preirradiated region infradiaphragmatically)? Would it make sense to do IF-RT but add to that, the area were the cells possibly crossed over, kind of like a "bridge". That would mean adding common iliac left&right plus 2-3 cms of lowest paraaortal region?
3. Should I ask the medical oncologists to give him rituximab as maintenance therapy after RT?
My answers:
1. 36 Gy
2. strictly IF-RT
3. Yes
I treated a 40 year old male 1,5 years ago with a stage I A follicular lymhoma G2 in the left groin. The patient received 30 Gy IF-RT (inguinal & external iliac lymph nodes), followed by a boost to a total of 36 Gy at the left groin. The mass on the left groin was gone after radiation therapy, he tolerated the treatment quite well.
He has now developed a new enlarged lymph node at the right groin, biopsy showed follicular lymphoma again. FDG-PET-CT shows, that this is the only disease currently present.
He was referred by the medical oncologists for treatment and I am gonna treat him.
Questions:
1. I pondered, if I should give him 2x2 Gy, since its a recurrence and probably palliative treatment. While I was reviewing the plan of the last treatment, I saw that we actually did a 4 field box for the other side, thus around 20% of the dose had partially covered the now involved site back then. If microscopic disease was present in the left groin (but undetected by the initial FDG-PET-CT) back then, 20% of 30 Gy = 6 Gy (given over 3 weeks), may have been enough to kill it, if the tumor was highly radiation sensitive. They obviously failed to do so, so I don't think 2x2 Gy are gonna work. Furthermore he's young and despite having a recurrence, he still has a lot of treatment options left. So maybe I should treat him aggressively?
2. I pondered about the volume to irradiate. I did IF-RT back then for the left side, but the lymphoma crossed to the other side.
Would it make sense to go for EF-RT and treat right groin, complete right iliac region, upper iliac left region and paraaortal too (thus practically leaving out only the preirradiated region infradiaphragmatically)? Would it make sense to do IF-RT but add to that, the area were the cells possibly crossed over, kind of like a "bridge". That would mean adding common iliac left&right plus 2-3 cms of lowest paraaortal region?
3. Should I ask the medical oncologists to give him rituximab as maintenance therapy after RT?
My answers:
1. 36 Gy
2. strictly IF-RT
3. Yes
