1. Palliative Single 8 Gy Radiotherapy for Symptomatic Aggressive Lymphomas 2666 Ａ -408 Oguchi M, Eba J, Tanaka O, Kozuka T, Murofushi K, Toshiyasu T, Tsurugai Y, Onoe T, Nose T, Yamashita T. Dept. Radiation Oncology. Cancer Institute Hospital The Japanese Foundation for Cancer Research, Tokyo

2. Background Several studies have shown the value of 4 Gy involved field radiotherapy (IFRT) in recurrent indolent lymphomas. Aggressive lymphomas have been initially treated with higher dose of IFRT than indolent lymphomas. The palliative radiotherapy for aggressive lymphomas has rarely been documented.

3. AuthorTitleJournalyear Murthy VEfficacy of palliative low-dose involved field radiation therapy in advanced lymphoma: a phase II study. Clin Lymphoma & Myeloma 2008 Haas RLEffective palliation by low dose local radiotherapy for recurrent and/or chemotherapy refractory non- follicular lymphoma patients. Eur J Cancer2005 Haas RLHigh response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas. J Clin Oncol2003 Johannsson JPhase II study of palliative low-dose local radiotherapy in disseminated indolent non- Hodgkin’s lymphoma and chronic lymphocytic leukemia. Int J Radiat Oncol Biol Phys 2002 Sawyer EJLow dose palliative radiotherapy in low grade non- Hodgkin’s lymphoma. Radiother Oncol 1997

4. Purpose/Objective To determine the efficacy and safety of single 8 Gy palliative radiotherapy for patients with symptomatic refractory or advanced aggressive lymphomas.

5. Materials/Methods: This retrospective analysis consists of 75 sites in 28 patients with refractory aggressive lymphomas and impaired PS. The 8 Gy single fractionation involved field radiotherapy was administered in each site with appropriate techniques from 2002 to 2008. (PTV = GTV + 1 cm margin)

6. Patients: Their symptoms included pain, discomfort, bulky mass, jaundice and obstruction. Median age was 72 years old (range: 40-94). A median of 3 prior regimens of intensive chemotherapy were proceeded local palliative radiotherapy. The median follow up was 6 months. (range: 3-40)

7. Pathologyn DLBCL18 PTCL (AILT)4 (1) MCL2 ALCL3 NKTL1 PS(ECOG)n 05 17 2-316

8. Results: Effectiveness Median time to symptomatic progression was 4 months (range: 0-40). Symptomatic Response% CR4131/75 PR4836/75 SD/PD118/75 89%

9. Results: Effectiveness Median time to progression in tumor size was 4 months (range: 0-40). Response in Tumor size% CR3526/73 PR2922/73 SD/PD3627/73 64%

10. Results: Toxicity Temporary grade 1 acute mucositis was found in 3 sites irradiated to the head & neck mass. Retreatment was needed for 5 sites due to their persistent pain.

11. Case presentation Pre-XRT Gad-T1 MR Post-XRT: 7 months PET/CT

12. Conclusions Palliative radiotherapy of 8 Gy single fractionation is valuable asset in the management of patients with symptomatic refractory or advanced aggressive lymphomas.

13. Acknowledgement Cancer Institute Hospital Dept. Medical Oncology / Hematology Drs. Hatake, Terui, Yokoyama, etc Cancer Institute Dept. Pathology Dr. Takeuchi K.