Increased Morbidity, Mortality Linked to Involved Field Radiation Therapy Prior to Total Body Irradiation in Lymphoma Patients A DGReview of :"Localized radiation increases morbidity and mortality after TBI-containing autologous stem cell transplantation in patients with lymphoma" By Jill Taylor Involved field radiation therapy (IFRT) prior to total body irradiation (TBI) is associated with higher treatment-related mortality in lymphoma patients undergoing autologous peripheral stem cell transplant (PSCT), report researchers. "Our data raise concerns regarding the use of IFRT in the immediate pretransplant period and suggest that the advantage of improving the tumour control with pretransplant irradiation should be carefully weighed against a definite increase in morbidity and mortality," say Christos Emmanouilides, MD, and colleagues of the University of California in Los Angeles, United States. In the treatment of lymphoma, adjuvant IFRT prior to transplant minimizes bulky disease, making high-dose chemotherapy (HDC) more effective. Administered after HDC, IFRT helps to avoid exposure of reinfused stem cells to myelosuppressive therapy. However, potential concerns in patients receiving thoracic radiation prior to transplant include increased pulmonary morbidity and incidence of secondary myelodysplasia and thyroid or cardiac toxicity. Additionally, the optimal extent, timing, and dose of involved field radiation in the transplant setting remain unknown. To study the effects of additional pretransplant radiation in intensive regimens, the researchers retrospectively assessed the relationship between IFRT and treatment-related morbidity and mortality in 156 patients receiving HDC, TBI and autologous PSCT for Hodgkin's (HL) and non-Hodgkin's lymphoma (NHL). Among the study population, 21 patients were identified who had received IFRT. Of these, 8 patients had HL and 13 patients had NHL. IFRT was given to 18 patients before TBI (5 HL patients and 13 NHL patients) and in 3 HL patients after TBI. A total of 12 patients (3 HL patients and 9 NHL patients) received IFRT proximal to transplant, and 6 (2 HL patients and 4 NHL patients) received IFRT remote to transplant. The researchers observed an increased incidence of treatment-related deaths in the radiation group, with 5 treatment-related deaths noted in the 19 patients who received IFRT prior to TBI (26%), compared to 7 of 135 patients (5%) who received only TBI prior to autologous PSCT. Furthermore, a higher incidence of pneumonitis was noted in patients who received IFRT proximal to TBI. No adverse impact on long-term survival could be demonstrated and no relationship was confirmed between treatment-related death and IFRT location. The investigators conclude that further studies are needed to better define the optimal population who may benefit from IFRT prior to HLC, and identify those subsets that are at higher risk of radiation-induced morbidity. Thanks to docguide.com, 11/03 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.