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Radiation therapy for the liver for malignant lymphoma

General

Indications

The liver is often involved with lymphoma as part of advanced disease and usually with multiple lesions or diffuse spreading in the liver. This applies to both Hodgkin's lymphoma and all forms of non-Hodgkins lymphoma. In most cases, patients will be candidates for chemotherapy primarily for advanced disease and only isolated residual lesions are suitable for radiation therapy. Primary extranodal involvement in the liver with only localized focal lymphoma spreading to the liver is very rare, and even then should it be considered whether to treat as advanced disease. 

Since the tolerance for ionizing radiation for the entire liver is likely slightly under 30 Gy (TD5/5 for liver failure), irradiation of the entire organ is difficult if it is desired to give doses the same as for malignant lymphomas. Irradiation of up to 1/3 of the liver is, however, possible with doses up to 50 Gy.

Curative radiation therapy

  • Isolated residual lesions after chemotherapy for the respective lymphoma may be appropriate for consolidative radiation therapy. 
  • Primary extranodal involvement in the liver with focal lymphoma spreading (stage PeI) is very rare. In such a case, treatment for advanced disease with chemotherapy and radiation therapy should still be considered only for possible residual lesions. 

Palliative radiation therapy

  • For palliative radiation therapy, the method usually follows the same guidelines as for curative therapy with individual modifications.
  • Smaller doses to the entire liver are considered for local symptoms such as liver involvemet and capsule pain. 

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