Definitive radiotherapy for localized follicular lymphoma staged by 18F-FDG PET-CT: a collaborative study by ILROG

Jessica L Brady, Michael S Binkley, Carla Hajj, Monica Chelius, Karen Chau, Alex Balogh, Mario Levis, Andrea Riccardo Filippi, Michael Jones, Michael Mac Manus, Andrew Wirth, Masahiko Oguchi, Anders Krog Vistisen, Therese Youssef Andraos, Andrea K Ng, Berthe M P Aleman, Seo Hee Choi, Youlia Kirova, Sara Hardy, Gabriele ReinartzHans T Eich, Scott V Bratman, Louis S Constine, Chang-Ok Suh, Bouthaina Dabaja, Tarec C El-Galaly, David C Hodgson, Umberto Ricardi, Joachim Yahalom, Richard T Hoppe, N George Mikhaeel

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70 Citations (Scopus)


Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50%. As 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60% of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ‡24 Gy, staged by PET-CT, age ‡18 years, and follow-up ‡3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1%) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9% and 95.7%. For stage I, FFP was 74.1% vs 49.1% for stage II (P < .0001). Eight patients relapsed in-field (1.6%). Four had marginal recurrences (0.8%) resulting in local control rate of 97.6%. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95% CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated.

Original languageEnglish
Issue number3
Pages (from-to)237-245
Number of pages9
Publication statusPublished - 2019

Bibliographical note

© 2019 by The American Society of Hematology.


  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fluorodeoxyglucose F18
  • Follow-Up Studies
  • Humans
  • Lymphoma, Follicular/diagnostic imaging
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local/diagnostic imaging
  • Positron Emission Tomography Computed Tomography/standards
  • Prognosis
  • Radiopharmaceuticals
  • Radiotherapy/mortality
  • Retrospective Studies
  • Survival Rate
  • Young Adult


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