Radiotherapy of stage IEA primary breast lymphoma: case report

A 47-year-old woman was referred for the treatment to our Hospital because of a palpable nodule in the upper medial quadrant of her right breast. After tumor excision, pathohistological examination showed a follicular center cell lymphoma grade 2, B-cell type (CD20+, bc16+, CD10+, bcl2+). The final diagnosis was stage IEA primary extranodal non-Hodgkin s breast lymphoma. The involved breast was irradiated isocentrically with two opposite 6-megavolt (MeV) photon beams delivered from the linear accelerator (tangential fields) using asymmetric collimator opening. Radiation volume, inclinations of the medial and lateral field, and the part of the underlying chest wall and lung parenchyma were determined during the radiotherapy simulation process. The total irradiation dose was 44 Gy delivered in single daily doses of 2 Grays (Gy). After breast photon irradiation, a boost to the tumor bed was performed by a direct 12 MeV electron beam, with a total dose of 6 Gy delivered over three days. Since primary non-Hodgkin lymphoma of the breast is rather rare, there has been no uniform approach to its treatment. The advantage of applying the asymmetric collimator jaw opening in breast radiotherapy is the instant reduction of the dose at margin fields, resulting in both the protection of neighboring lung parenchyma and the good coverage of planned target volume.