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Radiation therapy for bone with malignant lymphoma

General

Indications

Malignant lymphomas originating in the bone are rare, except for solitary plasmacytoma. If localized malignant lymphomas in the bone are present, there is often uncertainty whether they should be staged as PeI and treated accordingly or be considered cases of primary generalized disease. Bone involvement occurs most often as part of generalized disease of all histological subgroups of Hodgkin's and Non-Hodgkin lymphoma. Bone involvement can also occur as a local extension of lymphoma in the legs, for example from extranodal lymphomas in the nose/sinuses and from retroperitoneal nodal tumors with spinal invasion.

Myeloma is usually associated with bone involvement, and most patients are candidates for radiotherapy during the course of the disease.

Curative radiation therapy

  • Histology and stage determine whether treatment can be curative. 
  • For isolated unifocal bone involvement of indolent lymphomas or solitary plasmacytoma, radiotherapy alone can be given with a curative intention. 
  • For isolated bone involvement, bone involvement as part of generalized disease, or extension to legs from surrounding structures of Hodgkin's or aggressive non-Hodgkin lymphoma, it is indicated to irradiate after curative chemotherapy, but only if there is one or maximum two areas of bone involvement. If radiation therapy is given, it is to be given to the entire area with initial bone involvment even if the tumor has responded well to chemotherapy. With more than two areas of bone involvement, spreading to the bone is considered generalized and radiotherapy to all lesions is not sensible.

Palliative radiation therapy

  • According to regular palliative guidelines, it is appropriate to irradiate bone involvement in danger of fracture, pain, or compression of the spinal cord and other neurogenic tissue.

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