Very low-dose radiotherapy for extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue

Figures & data

Figure 1. Response to very low-dose radiotherapy. (A,B) Coronal (A) and axial (B) images demonstrating the radiation plan for a 67-year-old woman with stage IE BALT lymphoma of the left upper lobe treated with 4 Gy in 1 fraction. Color wash shows radiation dose. (C,D) PET/CT images in a 64-year-old man with stage IE BALT lymphoma of the right upper lobe (RUL) before (A, SUV 3.8) and 2 months after treatment with 4 Gy in 2 fractions (B, SUV 1.2). (E,F) PET/CT images in a 60-year-old woman with recurrent BALT lymphoma of the RUL before (C, SUV 10.1) and 6 months after treatment with 4 Gy in 2 fractions (D, SUV 1.9). (G,H). PET/CT images for the patient shown in (A, B) before (A, SUV 1.6) and 3 months after radiotherapy (F, SUV 0.6).

Table 1. Patient characteristics.

	No. (%)
Median age (years)	67
Sex
Female	8 (62)
Smoking status
Never	6 (46)
Current	0 (0)
Past (≤10 years)	1 (8)
Distant past (>10 years)	6 (46)
COPD	0 (0)
Autoimmune/connective tissue disease	0 (0)
History of cancer	5 (38)
Cancer during follow up	1 (8)^a
Symptoms prior to RT
Dyspnea	4 (31)
Cough	2 (15)
B symptoms	0 (0)
KPS
≤70	0 (0)
Bilateral lung involvement	4 (31)
No. of lesions
1	8 (62)
≥2	5 (38)
Median size, cm^b	3.6 (0.8 − 8.2)
Size category, cm^b,c
≤1	2 (13)
>1 to ≤2	2 (13)
>2	11 (73)
Nodal disease in chest	1 (8)
Anemia (Hb <11.2 g/dL)	1 (8)
Neutropenia (<1.5 x 10^3/μL)	0 (0)
Thrombocytopenia (<150 x 10^3/μL)	1 (8)
LDH > ULN^d	1 (13)

^aMyelodysplastic syndrome.

^bOf 15 treated lesions.

^cLargest diameter.

^dPre-RT LDH prior to radiotherapy available for 8 patients.

Table 2. Treatment outcomes.

Sex, age (y)	Initial management strategy	Tumor maximum diameter (cm)	RT dose (Gy)/ fractions	Treatment response	Recurrent disease	Outcome	Follow-up from diagnosis (mo)
M, 64	Radiotherapy	6.2	4 Gy/2	CR	No	Alive	24
F, 52	Radiotherapy	1.0	4 Gy/2	CR^a	No	Alive	21
M, 80	Initial wedge resection for solitary LUL mass with bilateral lung recurrence (including at site of prior LUL mass) 5 y later s/p rituximab (8 cycles) (progressive disease in bilateral lung masses 1 y later)	5.8, 3.6	4 Gy/2	PR^a, PR^a	No	Dead	94
F, 49	Rituximab (4 cycles) for bilateral lung masses with oligoprogressive RUL lesion 6 y later s/p rituximab (8 cycles) (oligoprogressive RUL lesion 2 y later)	5.8	4 Gy/2	CR	No	Alive	176
F, 69	Rituximab (1 cycle, stopped for DVT) for bilateral lung masses (progressive disease in bilateral lungs 1 y later)	8.2, 4.5	4 Gy/2	PR, CR	Progression in non-irradiated RUL lesion 2 mo later	Alive	59
F, 71	Active surveillance for solitary RUL mass (progressive disease in RUL lesion 1 y later)	1.7	4 Gy/2	CR	No	Alive	24
M, 79	Active surveillance for solitary RUL mass (progressive disease in RUL lesion later)	5.9	4 Gy/2	PR	No	Alive	13
F, 67	Active surveillance for solitary LUL mass	1.7	4 Gy/1	CR	No	Alive	10
F, 65	Radiotherapy	2.7	24 Gy/12	PR	No	Alive	27
M, 68	Radiotherapy	0.8	30 Gy/20	CR	Distant recurrence in retro­peritoneal lymph nodes 78 mo later	Alive	122
F, 84	Rituximab (4 cycles) for solitary right lung mass (local progression 1 y later)	3.6	30 Gy/20	CR	No	Dead	139
F, 48	Initial right middle lobectomy for solitary RML mass with LUL recurrence 2 y later s/p wedge resection (oligoprogressive RUL lesion 6 y later)	2.3	30 Gy/15	CR^a	Regional recurrence in RLL 17 mo later	Alive	194
M, 33	Radiotherapy	5.3	36 Gy/20	CR	No	Alive	81

^aCT-based response-assessment only.

Figure 2. Regional Failure after radiotherapy for BALT lymphoma. (A) Axial CT image in a 48-year-old woman with recurrent BALT lymphoma of the RUL before treatment with 30 Gy in 15 fractions. (B) Axial CT images showing a CR in the treated lesion (arrow, B’) and regional recurrence in the right lower lobe (arrowhead, B’’) 17 months after radiotherapy.