Ultra–Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung

Susan Y. Wu, MD; Penny Q. Fang, MD, MBA; Ahmed Fetooh, MBBS; Gohar S. Manzar, MD, PhD; Kelsey L. Corrigan, MD, MPH; Benjamin R. Schrank, MD, PhD; Lewis Nasr, MD, MS; Dai Chihara, MD, PhD; Luis E. Malpica Castillo, MD; Ranjit Nair, MD; Raphael E. Steiner, MD; Preetesh Jain, MBBS, MD, DM, PhD; Sattva S. Neelapu, MD; Paolo Strati, MD; Loretta J. Nastoupil, MD; Bouthaina S. Dabaja, MD; Chelsea C. Pinnix, MD, PhD; Jillian R. Gunther, MD, PhD

Advances in Radiation Oncology (Dec 2024)

Ultra–Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung

Susan Y. Wu, MD,
Penny Q. Fang, MD, MBA,
Ahmed Fetooh, MBBS,
Gohar S. Manzar, MD, PhD,
Kelsey L. Corrigan, MD, MPH,
Benjamin R. Schrank, MD, PhD,
Lewis Nasr, MD, MS,
Dai Chihara, MD, PhD,
Luis E. Malpica Castillo, MD,
Ranjit Nair, MD,
Raphael E. Steiner, MD,
Preetesh Jain, MBBS, MD, DM, PhD,
Sattva S. Neelapu, MD,
Paolo Strati, MD,
Loretta J. Nastoupil, MD,
Bouthaina S. Dabaja, MD,
Chelsea C. Pinnix, MD, PhD,
Jillian R. Gunther, MD, PhD

Affiliations

Susan Y. Wu, MD: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Penny Q. Fang, MD, MBA: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Ahmed Fetooh, MBBS: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Gohar S. Manzar, MD, PhD: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Kelsey L. Corrigan, MD, MPH: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Benjamin R. Schrank, MD, PhD: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Lewis Nasr, MD, MS: Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
Dai Chihara, MD, PhD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Luis E. Malpica Castillo, MD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Ranjit Nair, MD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Raphael E. Steiner, MD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Preetesh Jain, MBBS, MD, DM, PhD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Sattva S. Neelapu, MD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Paolo Strati, MD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Loretta J. Nastoupil, MD: Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
Bouthaina S. Dabaja, MD: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Chelsea C. Pinnix, MD, PhD: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Jillian R. Gunther, MD, PhD: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Corresponding author: Jillian R. Gunther, MD, PhD

Journal volume & issue: Vol. 9, no. 12
p. 101648

Abstract

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Purpose: Definitive intent radiation therapy (RT) for early-stage mucosa-associated lymphoid tissue (MALT) lymphoma typically includes a dose of 24 to 30 Gy. While modest, these doses may have associated toxicity. For patients with indolent B-cell lymphoma, there is increasing support for the use of ultra–low-dose RT (ULDRT) using 4 Gy in 2 fractions as part of a response-adapted approach, as high rates of complete response have been documented. This paradigm has been prospectively evaluated in the management of orbital and gastric indolent B-cell lymphomas; however, there is limited data guiding the use of ULDRT for lung MALT. Methods: We conducted a retrospective review of 20 patients at our institution with lung MALT treated with ULDRT as part of a response-adapted approach. Clinical variables including prior systemic therapy and symptoms were abstracted from the electronic health record. Responses were assessed using the revised Lugano criteria. Results: At a median follow up of 17 months following 4 Gy (IQR, 8-37 months), we observed 100% local control. Nineteen patients (95%) experienced a complete response. No patients with stage IE disease at RT (17/20; 85%) experienced distant progression. Nine patients (45%) were symptomatic prior to RT, with improvement or resolution of symptoms in 7 (7/9; 78%). One patient developed grade 2 pleuritic pain following RT, which resolved with a brief course of steroids. No other toxicities were noted. Conclusions: ULDRT, given in a response-adapted approach, is effective and well tolerated by patients with lung MALT.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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