Total body irradiation (TBI) as primary therapy for advanced lymphosarcoma

The natural history of lymphocytic lymphomas is such that diffuse involvement usually is present at diagnosis. Extensive lymphatic irradiation with tumoricidal doses is seldom an appropriate form of treatment, as most patients require systemic therapy. We have investigated total body irradiation (TBI) as an alternative to chemotherapy. A series of 39 consecutive untreated patients with generalized disease is reviewed. Actuarial 5-year survival rates for the well-differentiated, poorly differentiated nodular, and poorly differentiated diffuse histologic types are 100%, 78%, and 56% respectively. The single major complication, acute myelocytic leukemia, has developed in 2 of the 8 patients given extensive nodal irradiation as a supplement to TBI. None of the 31 patients receiving only TBI as initial therapy has shown evidence of a myeloproliferative disorder to date.