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Radiotherapy dose and fractionation regimens prescribed for Non-Hodgkin's Lymphoma (a local study)

Background: Non-Hodgkin's Lymphomas (NHL) are considered to be a highly radiosensitive group of diseases with radiotherapy playing a major role in their treatment. It is recognised that the different grades and stages of NHL require different treatment approaches with current recommendations including combined chemotherapy and radiotherapy, chemotherapy alone or radiotherapy alone. Despite these recommendations there still remains a variation in the radiotherapy dose and fractionation regimens prescribed for NHL and this could be attributed to a lack of written treatment protocols for these patients. This paper gives an overview of the literature and reports on a small local study. Method: A retrospective study recorded the treatment details of 35 patients treated with radiotherapy for NHL between April and September 1996 in a major radiotherapy centre. An analysis of the various radiotherapy dose and fractionation regimens identified was carried out and an attempt to identify the rationale behind the variations was made by correlating them to the grade of disease, the age of the patients, the prescribing consultants and whether chemotherapy was part of the treatment regimen. Results: Thirteen consultants were identified as prescribing treatment for NHL. Forty-nine percent of patients presented as low, 11% intermediate and 31% high grade NHL. Of the 60% of patients who underwent chemotherapy the majority (62%) were prescribed Cyclophosphamide, Hydroxydaunorubicin, Oncovin (Vincristine) and Prednisolone (the CHOP regimen). Nineteen different radiotherapy dose and fractionation regimens were identified, 20 Gy in 5 fractions being the most common. No correlation was found between the age of the patients and the radiotherapy dose delivered. A strong positive relationship (r = 0.95) was identified between the radiotherapy dose and the number of fractions. There was no effect on the radiotherapy dose delivered between the different grades of disease or whether chemotherapy was administered. Conclusions: It is considered that the implementation of a NHL treatment protocol is important and in an attempt to initiate this, specific NHL teams should be formed.