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Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients: a single-centre experience

  • Radiotherapy
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Abstract

Purpose

Data on efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients are scarce. We therefore performed this retrospective study to analyse our experience with radiotherapy exclusively to infradiaphragmal fields.

Materials and methods

we retrospectively evaluated 101 patients treated between 2003 and 2014. Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy.

Results

After a median follow-up of 66 months (range 1–211 months), we observed lymphoma recurrence in 38 patients (38%), five in the RT field and 33 out-of-field. Recurrences were significantly more frequent in the salvage group (17 out-of-field and 4 in-field in 31 patients) than in adjuvant group (16 out-of-field and 1 in-field in 70 patients; p < 0.001).

The 2-, 5- and 10-year event-free survival (EFS) rates were 62%, 56% and 54%. The 2-, 5- and 10-year overall survival (OS) rates for the entire group of patients are 73%, 60% and 54%, respectively. Acute side effects occurred in 43 (43%) patients, most frequent gastrointestinal in 26 (26%) patients. Late side effects occurred in 12 (12%) of all patients, 6 of 23 (26%) followed up for more than 10 years. Six patients developed secondary cancers, four gastrointestinal disturbances, two diabetes mellitus and three renal failure.

Conclusion

Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy. However, patients should be monitored for a secondary malignancy.

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The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Author notes

  1. Josip J. Grah

    Present address: Department for Radiotherapy, Univ. Klinik Für Strahlentherapie-Radioonkologie- LKH Graz, Graz, Austria

Authors and Affiliations

  1. Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Lea Galunic Bilic, Fedor Santek & Josip J. Grah

  2. School of Medicine, University of Zagreb, Zagreb, Croatia

    Fedor Santek, Slobodanka Ostojic Kolonic, Zdravko Mitrovic & Igor Aurer

  3. Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Sandra Basic-Kinda, Marijo Vodanovic, Dino Dujmovic & Igor Aurer

  4. Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia

    Inga Mandac Smoljanovic & Slobodanka Ostojic Kolonic

  5. Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia

    Zdravko Mitrovic

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by FS, JJG, SBK, IMS, ZM, MV, DD and SOK. The first draft of the manuscript was written by Lea GB and IA. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lea Galunic Bilic.

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This was a retrospective study using anonymized patient data, performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committees of our institution and Medical School.

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Galunic Bilic, L., Santek, F., Grah, J.J. et al. Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients: a single-centre experience. Radiol med 128, 492–500 (2023). https://doi.org/10.1007/s11547-023-01615-8

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