Indolent, Stage I and Contiguous Stage II Adult NHL

Current Clinical Trials

Although localized presentations are uncommon in NHL, the goal of treatment should be cure of the disease in patients who are shown to have truly localized occurrence after undergoing appropriate staging procedures. Long-term disease control within radiation fields can be achieved in a significant number of patients with indolent stage I or stage II NHL by using dosages of radiation that usually range from 25 Gy to 40 Gy to involved sites or to extended fields that cover adjacent nodal sites.[1-4] Almost half of all patients treated with radiation therapy alone will relapse out-of-field within 10 years.[5] The value of adjuvant treatment with rituximab or chemotherapy in addition to radiation to decrease relapse, has not been confirmed.[6,7]

When radiation therapy is contraindicated, chemotherapy can be employed for symptomatic patients (as outlined below for more advanced-stage patients), or watchful waiting can be considered for asymptomatic patients.[8] A retrospective analysis of the SEER database over 30 years showed improved outcomes for upfront radiation therapy, but one must be very cautious about this type of retrospective analysis. Watchful waiting has never been compared with upfront radiation therapy in a prospective randomized trial.[9]

Patients with involvement not encompassable by radiation therapy are treated as outlined for patients with stage III or stage IV low-grade lymphoma. Follicular large cell and mantle cell NHL are often treated as aggressive lymphomas (nodal and extranodal presentations).

Standard treatment options:

1. Involved-field radiation therapy.[1-4]
2. Watchful waiting.[8]
3. Chemotherapy with radiation therapy.[7]
4. Extended (regional) radiation therapy as prophylaxis for adjacent nodes.[1-4,10]
5. Rituximab, an anti-CD20 monoclonal antibody, either alone or in combination with chemotherapy and extrapolated from trials of patients with advanced-stage disease.
6. Other therapies as designated for patients with advanced-stage disease.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with indolent, stage I adult non-Hodgkin lymphoma and indolent, contiguous stage II adult non-Hodgkin lymphoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References

1. Mac Manus MP, Hoppe RT: Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University. J Clin Oncol 14 (4): 1282-90, 1996.  [PUBMED Abstract]
   
   
2. Vaughan Hudson B, Vaughan Hudson G, MacLennan KA, et al.: Clinical stage 1 non-Hodgkin's lymphoma: long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy. Br J Cancer 69 (6): 1088-93, 1994.  [PUBMED Abstract]
   
   
3. Denham JW, Denham E, Dear KB, et al.: The follicular non-Hodgkin's lymphomas--I. The possibility of cure. Eur J Cancer 32A (3): 470-9, 1996.  [PUBMED Abstract]
   
   
4. Haas RL, Poortmans P, de Jong D, et al.: High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas. J Clin Oncol 21 (13): 2474-80, 2003.  [PUBMED Abstract]
   
   
5. Guadagnolo BA, Li S, Neuberg D, et al.: Long-term outcome and mortality trends in early-stage, Grade 1-2 follicular lymphoma treated with radiation therapy. Int J Radiat Oncol Biol Phys 64 (3): 928-34, 2006.  [PUBMED Abstract]
   
   
6. Kelsey SM, Newland AC, Hudson GV, et al.: A British National Lymphoma Investigation randomised trial of single agent chlorambucil plus radiotherapy versus radiotherapy alone in low grade, localised non-Hodgkins lymphoma. Med Oncol 11 (1): 19-25, 1994.  [PUBMED Abstract]
   
   
7. Seymour JF, Pro B, Fuller LM, et al.: Long-term follow-up of a prospective study of combined modality therapy for stage I-II indolent non-Hodgkin's lymphoma. J Clin Oncol 21 (11): 2115-22, 2003.  [PUBMED Abstract]
   
   
8. Advani R, Rosenberg SA, Horning SJ: Stage I and II follicular non-Hodgkin's lymphoma: long-term follow-up of no initial therapy. J Clin Oncol 22 (8): 1454-9, 2004.  [PUBMED Abstract]
   
   
9. Pugh TJ, Ballonoff A, Newman F, et al.: Improved survival in patients with early stage low-grade follicular lymphoma treated with radiation: a Surveillance, Epidemiology, and End Results database analysis. Cancer 116 (16): 3843-51, 2010.  [PUBMED Abstract]
   
   
10. Ha CS, Kong JS, Tucker SL, et al.: Central lymphatic irradiation for stage I-III follicular lymphoma: report from a single-institutional prospective study. Int J Radiat Oncol Biol Phys 57 (2): 316-20, 2003.  [PUBMED Abstract]