Radioterapia em linfomas não-Hodgkin
DOI:
https://doi.org/10.32635/2176-9745.RBC.1992v38n2/3.3079Keywords:
Non-Hodgkin’s Lymphomas, Radiation TherapyAbstract
The Non Hodgkin lymphomas (NHL), as all malignant lymphomas, are very responsive to radiation therapy (XRT). Doses of 3,500 to 4,500 cGy at standard fractionation of 900 to 1,000 cGy per week, wíth megavoltage photons, should provide local control with almost no damage to nelghbor normal tissue. However, most NHL Show advanced stage at first sight and that makes exclusive radiation a limited option of treatment to NHL. XRT in children have still more limited Indications because radiation may cause deformities in bone and muscles. Patients with NHL that can benefit from exclusive XRT are mostiy adults with low grade and localized tumors (stages I and some II), or with large cell lymphomas, stage I. More advanced cases and those with more agressive histologies neeá combined modality treatments or even just chemotherapy. Optim radiation management programs for the NHL require adequate equipment including simulator and megavoltage machines and that is many times difflcult in Brazil. It remains to be defined the exact extension of the fields and the ideal doses, particularly in combined treatments. Extended fields like the “mantie” field or “inverted Y" field have been used less frequently; involved fields that implies treatment limited to the involved lymphoid region has been more often utilized in combined treatments. Generally XRT has been used after chemotherapy, but some programs alternate both modalities. XRT has been indicated in prophylaxis of CNS in patients with high risk for CNS involvement but this issue has not been resolved yet.
Downloads
References
LINK MP, DONALDSON SS, BERARD CW, SHUSTER JJ, MURPHY SB. Results of treatment of childhood localized non-Hodgkin’s lymphoma with combination chemotherapy with or without radiotherapy. N EngI J Med 1990; 322:1169-1174. DOI: https://doi.org/10.1056/NEJM199004263221701
KEPLAN HS. Hodgkin’s disease. 2nd ed. Cambridge, Harvard University Press, 1980: 52.
The non-Hodgkin’s lymphoma pathologic classification project: NCI sponsored study or classifications of non-Hodgkin’s lymphomas: summary and description of a working formulation for clinical usage. Câncer 1982; 49:2112-3135. DOI: https://doi.org/10.1002/1097-0142(19820515)49:10<2112::AID-CNCR2820491024>3.0.CO;2-2
NCI non-Hodgkin’s classification project writting committee: classification ofnon-Hodgkin’s lymphomas: Reproducibility of major classification systems. Câncer 1985; 55:91-95. DOI: https://doi.org/10.1002/1097-0142(19850101)55:1<91::AID-CNCR2820550115>3.0.CO;2-K
FARIA SL. Doença de Hodgkin na infância. Campinas, tese de doutoramento, FCM Unicamp. Departamento de Anatomia Patológica, 1991.
Hoppe RT. The non-Hodgkin's lymphomas: pathology, staging, treatment. Current problems in cancer 1987; 11:363-434. DOI: https://doi.org/10.1016/S0147-0272(87)80006-5
BRUMINI R. Câncer no Brasil, dados histopatológicos. Rio de Janeiro, Campanha Nacional de Combate ao Câncer. Ministério da Saúde, 1982.
ULTMAN JE, BILTRAN JD. Current recommendations for the staging and restaging of lymphoma. Current Opinion in Oncology, 1969; 1: 17-22. DOI: https://doi.org/10.1097/00001622-198910000-00005
CARBONE PP, KAPLAN HS, MUSHOFF K et al. Report of the committee on Hodgkin’s disease staging classification. Cancer Res 1971; 31: 1860-1861.
DIXON DO, NEILAN B, JONESSE et al. Effect of age on therapeutic outcome in advanced diffuse histiocytic lymphoma: The Southwest Oncology Group experience. J Clin Oncol 1986; 4: 295-305. DOI: https://doi.org/10.1200/JCO.1986.4.3.295
JAGANNATH S, VELASQUEZ WS, TUCKER SL et al. Tumor burden assessment and its implication for a prognostic model in advanced diffuse large-cell lymphoma. J Clin Oncol 1986; 4: 859-865. DOI: https://doi.org/10.1200/JCO.1986.4.6.859
KAMINSKI MS, COLEMAN CN, COLBYTVetal. Factors predicting survival in adults with stage I and II large-cell lymphoma treated with primary radiation therapy. Ann Intern Med 1986; 104: 747-756. DOI: https://doi.org/10.7326/0003-4819-104-6-747
CALMON LC. Situation of radiotherapy in Latin America. Int J Radiation Oncology Biol Phys 1990; 19:1267-1270. DOI: https://doi.org/10.1016/0360-3016(90)90241-B
FARIA SL, CHIMINAZZO JR H, SCHLUPP WR et al. Considerações sobre a radioterapia na doença de Hodgkin. Radiol Bras 1986; 19: 209-213.
COSSET JM, HENRY-AMAR M, GIRINSKI T et al. Late toxicity of radiotherapy in Hodgkin’s disease the hole of fraction size. Acla Oncologica 1988; 27: 123-129. DOI: https://doi.org/10.3109/02841868809090332
BITI G, COSSET JM, WOLF-PETERS C et al. Teaching course on new trends in the management of non-Hodgkin’s lymphomas. ESTRO - European Society for Therapeutic Radiology and Oncology. Firenze, 1990: 9-11.
LAWRENCE TS, URBA WJ, STEINBERG SM et al. Retrospectiva analysis of stage 1 and II indolent lymphomas at the National Cancer Institute. Int J Radiat Biol Phys 1988; 14: 417-424. DOI: https://doi.org/10.1016/0360-3016(88)90254-4
GOSPODAROWICZ MK, BUSH RS, BROWN TC et al. Prognostic factors in nodular lymphomas. A multivarlate analysis based on Pricess Margaret Hospital experience. Int J Radiat Oncol Biol Phys 1984; 10: 489-497. DOI: https://doi.org/10.1016/0360-3016(84)90028-2
BAJETTA E, VALAGUSSA P, BONADONNA G et al. Combined modality treatment for stage l-ll non-Hodgkin's lymphomas: CVP vs BACOP chemotherapy. int. J. Radiat. Oncol. Biol. Phys 1988: 15:3- 12. DOI: https://doi.org/10.1016/0360-3016(88)90340-9
Rosemberg SA: The low grade non-Hodgkin's lymphonias: challenges and opportunities. J. Clin. Oncol. 1985:3: 299-310. DOI: https://doi.org/10.1200/JCO.1985.3.3.299
YOUNG RC, LONGO DL, GLATSTEIN E et al. The treatment of indolent lymphomas: watchful wainting vs aggressive combined modality treatment. Semin Hematol 1988; 25(Suppl. 2): 11-16.
ACKER B, HOPPE RT, COLBY TV etal. Histologic conversion in the non-Hodgkin's lymphomas. J Clin Oncol 1983; 1:11-16. DOI: https://doi.org/10.1200/JCO.1983.1.1.11
FARIA SL, ALVARENGA M, PRANDO A et al. Linfomas não-Hodgkin em adultos - Revisão crítica dos pacientes tratados no Centro de Oncologia Campinas. Rev Ass Med Bras 1984; 30: 85-90.
VOKES EE, ULTMANN JE, COLOMB HM et al. Long term survival of patients with localized diffuse histiocytic lymphoma. J Clin Oncol 1985; 3: 1309-1317. DOI: https://doi.org/10.1200/JCO.1985.3.10.1309
LAMB DS, HUDSON GV, EASTERLING MJ etal. Localized grade 2 non-Hodgkin’s lymphoma: results of treatment with radiotherapy (BNLI report n° 24). Clin Radiol 1984; 35: 253-260. DOI: https://doi.org/10.1016/S0009-9260(84)80085-9
SUTCLIFFE SB, GOSPODAROWICZ MK, BUSH RS et al. Role of radiation therapy in localized non-Hodgkin’s lymphoma. Radiother Oncol 1985; 4: 211-223. DOI: https://doi.org/10.1016/S0167-8140(85)80086-4
LONGO DL. Combined modality therapy for localized aggressive lymphoma: enough or too much?J Clin Oncol 1989; 7:1179-1181. DOI: https://doi.org/10.1200/JCO.1989.7.9.1179
CONNORS JM, KLIMO P, FAIREY RN et al. Brief chemotherapy and involved fields radiation therapy for limited stage hystologically aggressive histology lymphoma. Ann Intern Med 1987; 107:25-29. DOI: https://doi.org/10.7326/0003-4819-107-1-25
DEVITA VT, HUBBARD SM, YOUNG RC et al. The role of chemotherapy in diffuse aggressive lymphomas. Seminars in Hematology 1988; 25: 107-115.
Yl PI, COLEMAN M, SALTZ L et al. Chemotherapy for large cell lymphoma: a status update. Seminars in Oncology 1990; 17: 119-132.
MACKINTOSH FR, COLBY TV, PODOLSKY WJ et al. Central nervous system involvement in non-Hodgkin's lymphoma: na analysis of 105 cases. Câncer 1982; 49: 586-595. DOI: https://doi.org/10.1002/1097-0142(19820201)49:3<586::AID-CNCR2820490331>3.0.CO;2-C
