Total-body irradiation in the treatment of lymphocytic lymphoma

Seventy-eight patients with advanced lymphocytic lymphoma have been treated by total-body irradiation (TBI) since 1969. Fifty-one of these patients received TBI as their initial and only primary therapy, and of these, 36 had a nodular histology and 15 had a diffuse histology according to the Rappaport classification. Treatment consisted of 15 rads twice weekly to 150 rads total dose. Persistent local tumors were given local boost irradiation. None of these 78 patients experenced significant morbidity; toxicity was confined to thrombocytopenia, and in 40% of the patients treatment was administered over a prolonged course to allow platelet recovery. Of the 51 patients who received TBI as primary treatment, 80% achieved a complete response for a median relapse-free survival of 24 months and an actuarial 5-year survival of 68%. TBI is an effective therapy in advanced lymphocytic lymphoma and produces long remissions without maintenance in many patients. It should be considered a systemic agent, and its use in combination with chemotherapeutic agents deserves further investigation.