Phase I study of escalating doses of low-dose-rate, locoregional irradiation preceding Cytoxan-TBI for patients with chemotherapy-resistant non-Hodgkin’s or Hodgkin’s lymphoma

• Published in: International journal of radiation oncology, biology, physics Vol. 57; no. 1; pp. 166 - 171
• Main Authors: Song, D.Y, Jones, R.J, Welsh, J.S, Haulk, T.L, Korman, L.T, Noga, S, Goodman, S, Herman, M, Mann, R, Marcellus, D, Vogelsang, G, Ambinder, R.F, Abrams, R.A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2003; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Bone Marrow Transplantation; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; Cyclophosphamide - therapeutic use; Dose-Response Relationship, Radiation; Hodgkin Disease - drug therapy; Hodgkin Disease - mortality; Hodgkin Disease - radiotherapy; Hodgkin Disease - therapy; Humans; Lymphoma; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - radiotherapy; Lymphoma, Non-Hodgkin - therapy; Maximum Tolerated Dose; Medical sciences; Middle Aged; Radiotherapy Dosage; Total body irradiation; Treatment Outcome; Whole-Body Irradiation - adverse effects; Whole-Body Irradiation - methods; Bone marrow transplantation; Lymphoma; Total body irradiation
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/S0360-3016(03)00508-X

In patients in whom bone marrow transplantation (BMT) fails, recurrence often occurs at sites known to have contained disease before initiating BMT. The purpose of this study was to find the maximal tolerable dose of locoregional irradiation (LRT) between 1000 and 2000 cGy that could be integrated with our Cytoxan-total body irradiation (TBI) BMT conditioning regimen in the treatment of lymphoma. Patients had Hodgkin’s or non-Hodgkin’s lymphoma in chemotherapy-refractory relapse. All patients received LRT to a maximum of three sets of fields encompassing either all current or all previously known sites of disease. Cytoxan-TBI consisted of cyclophosphamide 50 mg/kg daily for 4 days followed by TBI of 1200 cGy given in four fractions. Twenty-one patients were enrolled. Radiation Therapy Oncology Group Grade 3 in-field acute toxicity was observed in 1 patient at each dose level up to 1500 cGy and in 3 of 6 patients receiving 2000 cGy. Clinically evident late toxicities were limited to hypothyroidism and one second malignancy occurring outside the LRT fields. Low-dose-rate, LRT with concurrent Cytoxan-TBI before BMT has acceptable rates of in-field toxicity for doses up to 1500 cGy in five fractions. This regimen safely permits the use of a total combined radiation dose of up to 2700 cGy during 2 weeks, with encouraging in-field response rates in treatment-refractory patients.