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Radiation therapy for Waldeyer's ring with malignant lymphoma

General

Next to the gastrointestinal tract, Waldeyer's ring is is a common localization for extranodal lymphomas. Even though Waldeyer's ring is anatomically not lymph node region, it is considered a region for staging of malignant lymphomas according to the Ann Arbor classification. 

 

Lymphomas in this region are generally DLBCL, but follicular lymphomas also occur relatively often. 

The most common localization is the palatine tonsil followed by the nasopharynx and base of the tongue. Hodgkin's lymphoma rarely occurs in Waldeyer's ring. 

Curative radiation therapy

  • For localized stages of aggressive lymphomas (stage I-II1), consolidative radiation therapy after chemotherapy (CHOP-based or equivalent) to the original tumor-involved area with margin (involved field) is given. 
  • For residual tumor of aggressive lymphomas after full chemotherapy (6–8 CHOP-based cycles or equivalent), consolidative radiation therapy to the residual tumor with margin is considered. 
  • For indolent lymphomas with localized disease (stage I–II1), radiation therapy alone to the involved area with margin is given (involved field).  
  • Ved lokaliserte stadier av klassisk Hodgkin lymfom (stadium IA/IIA) gis strålebehandling mot opprinnelig tumoraffisert område med margin (”involved field”) etter kjemoterapi (ABVD eller tilsvarende).
  • For localized stages of classical Hodgkin's lymphoma (stage IA/IIA), radiation therapy is given to the original area involved with margin (involved field) after chemotherapy (ABVD or equivalent).
  • Special guidelines apply for children and adolescents up to 18 years with Hodgkin's lymphoma.
  • For residual tumor of Hodgkin's lymphoma after full chemotherapy for advanced Hodgkin's lymphoma (6-8 ABVD, 8 BEACOPP or equivalent), consolidative radiation therapy to the residual tumor with margin is considered. 

Palliative radiation therapy

  • As palliative radiation therapy, the method is based on guidelines for curative treatment with individual modifications.

     

 

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