Definitive radiotherapy for localized follicular lymphoma staged by18F-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%. As18F-fluorodeoxyglucose (18F-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
Pages (from-to)237-245
Number of pages9
Issue number3
Publication statusPublished - 2019 Jan 17

Bibliographical note

Publisher Copyright:
© 2019 by The American Society of Hematology.

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology


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