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Radiation therapy for lung for malignant lymphoma

General

Indications

With advanced lymphoma, the lungs are often involved and usually with multiple lesions. This applies to both Hodgkin's lymphoma and all forms of Non-Hodgkin lymphoma. In most cases, these patients will be candidates for primary chemotherapy as for advanced disease. With residual lesions, radiation therapy is considered in some cases. Since the tolerance for ionizing radiation for the entire lung is slightly below 18–20 Gy (TD5/5 for lung failure), irradiation of the entire organ is often difficult if it is desired to give doses the same as for malignant lymphoma. Therefore, consolidative radiaion therapy is given only under special circumstances to the entire lung or both with lower fractions and total doses than otherwise for lymphomas. Primary extranodal involvement of the lungs with only one localized focal lymphoma manifestation (considered stage PeI) is very rare, and even then it must be considered whether such cases should be treated as advanced disease and whether surgery should be chosen as local treatment in a curative plan.  

Curative radiation therapy

  • Residual lesions after chemotherapy each lymphoma where the clinical profile indicates that the chemotherapy effect should be consolidated in the lungs. This may apply to, for example, patients with recurrence of aggressive lymphomas or Hodgkin's lymphoma who are treated to cure the disease, and where lung manifestations (possibly together with mediastinal recurrence manifestations) dominate the clinical profile.
  • Patients under 18 years with Hodgkin's lymphoma with lung involvement will have radiation therapy for the lungs in primary treatment based on guidelines from protocol GPOH-HD-95 (selected patients only).   
  • Primært ekstranodal affeksjon i lungen med lokalisert fokal lymfomutbredelse (tenkt stadiumPeI) er svært sjelden. Dersom slikt forekommer, må en likevel vurdere om slike tilfeller bør behandles som utbredt sykdom med egnet kjemoterapi og om kirurgi skal velges som lokalbehandling i et kurativt opplegg.

Palliative radiation therapy

  • Palliative radiation therapy of entire or both lungs is almost never indicated. 

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