Highly effective local control and palliation of mantle cell lymphoma with involved-field radiation therapy (IFRT)

Purpose: Although radiosensitivity of mantle cell lymphoma (MCL) has been demonstrated in vitro, radiotherapy is rarely employed in treatment of MCL. We studied clinical responses of MCL patients treated with involved-field radiation therapy (IFRT) predominantly for local control and/or palliation. Methods and Materials: A total of 21 consecutive patients (38 sites) treated with IFRT for MCL were retrospectively analyzed. Median age was 68. Seventeen patients had Stage IV/relapsed disease, I had Stage II, and 3 had Stage I disease. Most patients received prior chemotherapy, with an average of two combinations per patient. Mean number of sites treated per patient was two. Mean total dose was 30 Gy. Results: Mean follow-up was 13 months. Overall local response rate was 100%. Complete response was obtained in 64% of the sites and partial response in 36%. Average time to response was 20 days. Twenty-eight sites had a response before radiation therapy was complete. Of 16 sites associated with pre-IFRT pain or discomfort, 15 exhibited post-IFRT relief. Thirteen sites (34%) exhibited local progression, with a median time to progression of 10 months, and an average response duration of 9 months. Five patients experienced Grade II radiation-related toxicity. No Grade III toxicity was reported. Twelve-month overall survival for patients receiving IFRT was 55%. Conclusions: Radiotherapy provided effective and lasting local responses in MCL patients and was associated with minimal toxicity. Radiation doses required for most lesions were relatively low and responses were noticed early in the course of treatment. Radiation therapy should be considered early in the course of relapsing, refractory, or localized MCL. (c) 2006 Elsevier Inc.