Abdominal irradiation after chemotherapy in non-Hodgkin's lymphoma: review of 32 patients.

Abstract Objective : Our objective is to evaluate the efficacy and toxicity of abdominal irradiation after chemotherapy in the management of Non-Hodgkin’s Lymphoma. Methods : Between 1982 and 1997, 32 patients underwent abdominal irradiation; as adjuvant treatment to chemotherapy (5 patients), as curative treatment for residual mass (9 patients) or as salvage treatment for refractory disease (18 patients). The dose administered to the total abdomen was 18–20 Gy at the rate of 1.5–1.8 Gy per daily fraction followed by a boost to gross disease up to a total dose of 40–44 Gy. All patients had received at least 6 cycles of Cyclophosphamide, Doxorubicin, Vincristin and Prednisone (CHOP). A follow-up could be obtained on all patients. Results : The in-field and out of field recurrence rates were 18 and 31%, respectively, for the entire group and 22 and 44%, respectively, for the palliative group. The 5- and 10-year survival rates were 100 and 80% for the adjuvant group, 45 and 24% for the curative group and 28 and 11% for the palliative group. The local contol was significantly better in patients with follicular type lymphoma than in those with the diffuse type. There was a 50% acute diarrhea, 19% grade 3/4 hematologic toxicity, 6% chronic enteritis, one late renal failure and three toxic deaths. Conclusion : Adjuvant whole abdominal irradiation is feasible and efficient in patients with Non-Hodgkin’s Lymphoma at high risk of intra-abdominal failure. Abdominal irradiation for residual disease consolidates remission with acceptable toxicity. Salvage radiotherapy for abdominal failure after chemotherapy provides significant palliation and prolongation of survival.