Changing practice in the radiation treatment of non-Hodgkin's lymphoma

Abstract

Background: Radiotherapy is well established in the treatment of non-Hodgkin's lymphoma (NHL) but there is considerable variation in the radiotherapy regimens prescribed, even within one cancer centre. This paper compares the varying radiation schedules prescribed in the Beatson Oncology Centre, Glasgow, in a sample of patients treated in 1996 with a second sample treated in 1999 following the creation of a lymphoma team with defined treatment protocols.

Method: In 1997 a retrospective study within the Beatson Oncology Centre recorded the treatment details of 35 patients treated with radiotherapy for NHL in 1996. The various radiotherapy dose and fractionation regimens prescribed were analysed to identify the rationale behind the variations by correlating them to the grade of disease, the age of the patient, the prescribing consultant and use of cytotoxic chemotherapy. A further audit of 36 patients treated over a three-month period in 1999 re-examined the radiotherapy prescribed and was able to include intent of treatment and stage of disease in the analysis.

Results: The demographics of the 1996 and 1999 patients were similar. In the latter group all patients had grade of disease recorded and 83% had stage recorded compared to 91% had grade and only 31% had stage recorded in 1996. The range of doses prescribed was 20–45 Gy (Gray) (median 36) for LGNHL (low grade non-Hodgkin's lymphoma) in 1996 with a range of 5–50 Gy (median 30) for HGNHL (high grade NHL). In 1999 the LGNHL range was 20–45 Gy (median 30) with HGNHL 20–50 (median 40). The 1999 audit showed better recording of data and this allowed further analysis of radiotherapy regimens. The patients could be grouped into three categories of treatment intent: primary radical treatment with radiotherapy alone (36%), consolidation following chemotherapy (25%) and palliation (39%). The radical and consolidation groups received similarly high doses (median 40 Gy) which were significantly greater than the palliation group (median 20 Gy).

Conclusions: The creation of a lymphoma team has improved the recording of treatment data and reduced the variations in clinical practice. We would advocate that patients with NHL should be irradiated according to evidence based protocols and suitable patients should be considered for the current BNLI trial of radiation dose in NHL.