non-hodgkin's%20lymphoma
NON-HODGKIN'S LYMPHOMA
Treatment Guideline Chart

Non-Hodgkin's lymphoma is a heterogeneous group of lymphoproliferative malignancies.
It is the most common hematologic cancer.
The most common subtypes are the diffuse large B-cell and follicular lymphoma. The subtypes are based on the malignant cell's morphology, genetic features, immunohistological characteristics, and stage of maturation.

Radiotherapy

  • Local radiotherapy is a recommended initial therapy for patients with limited stage disease as it increases survival rates in these patients
  • Studies have shown that addition of radiation therapy to chemotherapy in patients with bulky disease resulted in improved treatment outcome
  • Advanced RT delivery techniques such as intensity-modulated RT (IMRT), volumetric modulated arc therapy (VMAT), breath hold or respiratory gating, image-guided RT (IGRT), proton therapy should be considered in special cases where radiation exposure of specific organs are reduced while achieving the primary goal of local tumor control
  • Involved-site radiation therapy (ISRT) is the recommended appropriate field for NHL as it is aimed directly at the lymph nodes containing the involved structure and site of skin involvement on cutaneous lymphomas
    • Concentrated on the involved node and extranodal extensions, reducing the field exposed to radiation, thereby sparing other organs from unnecessary radiation exposure
    • Recommended doses:
      • FL, MZL: 24-30 Gy
      • MCL: 24-36 Gy
      • DLBCL: 40-55 Gy (as primary treatment); 20-36 Gy (in combination with HCT); 30-36 (after complete response to chemotherapy); 36-50 Gy (after partial response to chemotherapy); 40-55 Gy (refractory disease)
      • PTCL: 30-36 Gy (consolidation); 40-50 Gy (complementary with partial response to chemotherapy); 40-55Gy (as primary treatment); 20-36 Gy (in combination with HCT)
      • T-cell/NK-cell lymphomas: 50-55 Gy (as primary treatment); 45-56 Gy (in combination therapy)
      • MF/SS: 8-12 Gy; 24-30 Gy for unilesional presentation
  • External beam radiation therapy (EBRT) is an option for the initial management of patients with cutaneous lymphomas with solitary or regional disease
    • Recommended doses:
      • Primary cutaneous MZL and primary cutaneous follicle center lymphoma: 24-30 Gy
      • MF/SS: 8-12 Gy (individual plaque and tumor lesions); 24-30 Gy (unilesional presentation)
  • Total skin electron beam therapy (TSEBT), either alone or in combination with adjuvant therapy, may be considered for early-stage MF
    • Recommended dose: 30-36 Gy (conventional dose); <30 Gy (low dose)
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