[Radiographic staging procedures and radiotherapy of malignant lymphoma]

Radiographic studies play an important role in the clinical staging of malignant lymphoma (ML). Conventional procedures are plain chest X-ray, lymphangiography, gastrointestinal series, and 67Ga scintigraphy. Gastro-intestinal series is essential in non-Hodgkin's lymphoma (NHL) of Waldeyer's ring and thyroid. 67Ga scintigraphy is a non-invasive procedure useful in the screening of ML. Recently marked improvements have been made in the diagnostic modalities. CT scan and NMR have made it very easy to diagnose ML of the central nervous system and detect the extension of tumors at all sites. In some cases with Hodgkin's disease (HD), staging laparotomy is necessary, but not in cases with NHL. If tumors are localized, subtotal or total nodal irradiation is performed for patients with HD, and generous involved field is employed for NHL with or without combined chemotherapy at our department. Good local control is obtained except for NHL of the central nervous system at a total dose of 40-50 Gy. NHL is prone to relapse outside the radiation field. Therefore we consider that combined chemotherapy is indicated for NHL such as T-cell lymphomas, those with high grade histology classified according to the Working Formulation, and with involvement of lymph nodes larger than 6 cm in diameter.