Radiation therapy for non-Hodgkin's lymphoma

In this article, radiation therapy for non-Hodgkin's nodal and extranodal lymphomas is reviewed. For localized stage I and limited stage II nodal lymphomas, radiation therapy is potentially curative regardless of histology. For stage II and extensive stage I disease of diffuse histology, adjuvant chemotherapy should be considered. For stage III and IV nodal lymphomas of favourable cell type, complete remission after total body irradiation is often achieved and, in general, is as effective as combination chemotherapy. In advanced nodal lymphomas with unfavourable histology, local control is obtained with radiotherapy but early systematic failure is common so combination with chemotherapy is appropriate. Local control of gastric and small bowel lymphomas is achieved following postoperative radiotherapy and in advanced cases, chemotherapy should also be entertained. In patients with primary lymphoma of the brain, survival is prolonged following postoperative whole brain radiotherapy. Chemotherapy should be considered for recurrent or refractory CNS lymphoma. For lymphoma arising in Waldeyer's ring, radical radiotherapy is used and adjuvant chemotherapy may be appropriate for advanced local lesions. For primary lymphoma of the bone, radiotherapy is recommended for local or regional disease; for advanced local disease, combination chemotherapy with or without radiotherapy is used. (UK)