Question: Does Radiotherapy Help in Diffuse Large B-cell Lymphoma (DLBCL)?
Answer:
Diffuse Large B-cell Lymphoma (DLBCL) is the commonest type of Non-Hodgkin Lymphoma (NHL). Traditionally, treatment of DLBCL has been chemotherapy, as the disease potentially affects different parts of the body and treatment must reach all areas. Local treatment with radiotherapy was thought to have little role in a disease like this.
However, a number of trials have demonstrated that radiation may have a very important role to play in DLBCL. In early stage disease (Stage I and II) when the disease affects only a relatively small part of the body, radiation can be delivered after 3 to 8 cycles of chemotherapy with little additional toxicity. In these patients radiation to a dose of 30-40 Gy seems to benefit patients considerably.
Two large trials have demonstrated a significant delay in relapse with the addition of chemotherapy. This also leads to a 10-15% improvement in survival in the short term. Over a longer period of time, the benefit in survival reduces, as some patients have a delayed relapse. Results are better in those who have a smaller disease to start with.
In older individuals, however, radiation may not always be of benefit. A trial in Europe that reported its results in March 2007 has demonstrated that in those who are older than 60 years and have none of the bad prognostic factors associated with non-Hodgkin lymphoma, may not benefit from the addition of radiation to chemotherapy.
The role of radiation in higher stage disease (Stage III and IV) is also not clear. It helps in patients who have a less than complete response after chemotherapy to reduce disease bulk and symptoms. However it has not demonstrated a definite impact on survival or progression.
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