Maligne Lymphome sind primär eine Domäne der Systemtherapie. Nichtsdestotrotz hat die Strahlentherapie ihren Anteil insbesondere bei den frühen Stadien der indolenten Lymphome oder als Konsolidierung nach einer Chemotherapie. Die Indikationen zur Bestrahlung, das Ausmaß, die Dosis und die Technik der Bestrahlung von malignen Lymphomen haben sich in den letzten Jahren sehr geändert: Die Indikation ist spezifischer und die Bestrahlungen sind durch verschiedene Faktoren verträglicher geworden. Das sollte sich auch zu einem späteren Zeitpunkt bezüglich der Spätfolgen positiv auswirken. Der Artikel fasst die Entwicklungen der letzten Jahre zusammen.
Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Literatur
1
Andre MPE,
Girinsky T,
Federico M.
et al
Early Positron Emission Tomography Response-Adapted Treatment in Stage I and II Hodgkin Lymphoma: Final Results of the Randomized EORTC/LYSA/FIL H10 Trial. J Clin Oncol 2017; 35: 1786-1794
2
Radford J,
Illidge T,
Counsell N.
et al
Results of a trial of PET-directed therapy for early-stage Hodgkin’s lymphoma. New Engl J Med 2015; 372: 1598-1607
3
Fuchs M,
Goergen H,
Kobe C.
et al
Positron Emission Tomography-Guided Treatment in Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase III HD16 Trial by the German Hodgkin Study Group. J Clin Oncol 2019; 37: 2835-2845
4
Mac Manus MP,
Hoppe RT.
Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University. J Clin Oncol 1996; 14: 1282-1290
5
Stuschke M,
Hoederath A,
Sack H.
et al
Extended field and total central lymphatic radiotherapy in the treatment of early stage lymph node centroblastic-centrocytic lymphomas: results of a prospective multicenter study. Study Group NHL-fruhe Stadien. Cancer 1997; 80: 2273-2284
6
Engelhard M,
Unterhalt M,
Hansmann ML.
et al
Follicular lymphoma: Final results of the randomized evaluation of curative radiotherapy in limited stage nodal disease. Strahlentherapie und Onkologie 2013; 189: 36
7
MacManus M,
Fisher R,
Roos D.
et al
Randomized Trial of Systemic Therapy After Involved-Field Radiotherapy in Patients With Early-Stage Follicular Lymphoma: TROG 99.03. J Clin Oncol 2018; 36: 2918-2925
8
Herfarth K,
Borchmann P,
Schnaidt S.
et al
Rituximab With Involved Field Irradiation for Early-stage Nodal Follicular Lymphoma: Results of the MIR Study. HemaSphere 2018; 2: e160
9
Lowry L,
Smith P,
Qian W.
et al
Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: A randomised phase III trial. Radiother Oncol 2011; 100: 86-92
10
Hoskin PJ,
Kirkwood AA,
Popova B.
et al
4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non-inferiority trial. Lancet Oncol 2014; 15: 457-463
11
Herfarth K,
König L.
Strahlentherapie (4 Gy vs. 24 Gy) von Patienten mit indolentem Non-Hodgkin-Lymphom. Strahlentherapie und Onkologie 2014; 190: 1084-1085
12
Konig L,
Herfarth K,
Horner-Rieber J.
et al
Oncological outcome and recurrence pattern analysis after involved-field irradiation in combination with rituximab for early-stage nodal and extranodal follicular lymphoma. Strahlenther Onkol 2020; 196: 705-714
13
Knoops L,
Haas R,
de Kemp S.
et al
In vivo p53 response and immune reaction underlie highly effective low-dose radiotherapy in follicular lymphoma. Blood 2007; 110: 1116-1122
14
Fasola CE,
Jones JC,
Huang DD.
et al
Low-dose radiation therapy (2 Gy × 2) in the treatment of orbital lymphoma. Int Jo Radiat Oncol Biol Phys 2013; 86: 930-935
15
Konig L,
Horner-Rieber J,
Bernhardt D.
et al
Response rates and recurrence patterns after low-dose radiotherapy with 4 Gy in patients with low-grade lymphomas. Strahlenther Onkol 2018; 194: 454-461
17
Koch P,
del Valle F,
Berdel WE.
et al
Primary Gastrointestinal Non-Hodgkin’s Lymphoma: II. Combined Surgical and Conservative or Conservative Management Only in Localized Gastric Lymphoma – Results of the Prospective German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001; 19: 3874-3883
18
König L,
Dreyling M,
Dürig J.
et al
Therapy of nodal Follicular Lymphoma (WHO grade ½) in clinical stage I/II using response adapted Involved Site Radiotherapy in combination with Obinutuzumab (Gazyvaro) – GAZAI Trial (GAZyvaro and response adapted Involved-site Radiotherapy): a study protocol for a single-arm, non-randomized, open, national, multi-center phase II trial. Trials 2019; 20: 544-552
19
Held G,
Murawski N,
Ziepert M.
et al
Role of Radiotherapy to Bulky Disease in Elderly Patients With Aggressive B-Cell Lymphoma. J Clin Oncol 2014; 32: 1112-1118
20
Persky DO,
Li H,
Stephens DM.
et al
Positron Emission Tomography – Directed Therapy for Patients With Limited-Stage Diffuse Large B-Cell Lymphoma: Results of Intergroup National Clinical Trials Network Study S1001. J Clin Oncol 2020; 38: 3003-3011
21
Hayden A,
Tonseth P,
Lee DG.
et al
Outcome of Primary Mediastinal Large B-cell Lymphoma Using R-CHOP: Impact of a PET Adapted Approach Blood 2020 Jun 30; blood.2019004296.
22
Konig L,
Bougatf N,
Horner-Rieber J.
et al
Consolidative mediastinal irradiation of malignant lymphoma using active scanning proton beams: clinical outcome and dosimetric comparison. Strahlenther Onkol 2019; 195: 677-687
