Very Low-Dose RT Is Effective, Although Not Standard in Indolent Non-Hodgkin Lymphoma

Very low dose radiation therapy was found to be an effective treatment approach in the palliative setting for patients with indolent non-Hodgkin lymphoma.

Very low dose radiation therapy (VLDRT) was found to be an effective treatment approach in the palliative setting for patients with indolent non-Hodgkin lymphoma, but it is not considered a standard of care in this patient population, according to findings presented at the 47th Annual Oncology Nursing (ONS) Congress.1

Additionally, a benefit of VLDRT is that it allows retreatment to the same field as needed. While radiation-related toxicities were low in both VLDRT and standard radiation (RT) therapy groups, the shorter treatment schedule of 2 treatments vs 12 treatments is also a quality-of-life benefit in the palliative setting.

Preparation for either radiation dosing approach, as well as the timetable of scans to determine response to treatment, remains the same.

The goal of the research was to close the gap in oncology nursing literature and define the role of VLDRT in patients with indolent lymphomas, Catherine Adams, BSN, RN, OCN, of Memorial Sloan Kettering Cancer Center, and coinvestigators, wrote in the poster presentation.

“Standard treatment can be started immediately if VLDRT is not effective for control of localized disease,” the authors wrote. “VLDRT does not compromise future types of treatment.”

Indolent lymphomas, specifically follicular lymphomas and marginal zone lymphomas, are known to be very radiosensitive. Historically, patients with these malignancies have been treated with radiation doses at 40 Gy to 45 Gy for a total of 20 treatments.

Previous research has shown that 24 Gy for 12 treatments was also found to be effective for disease control in patients with localized follicular lymphoma.2 Additionally, data from the FORT trial (NCT00310167), which compared the use of 24 Gy with 4 Gy, showed that 24 Gy should be standard of care, though 4 Gy remains an optimal alternative in the palliative setting.3

In the poster presented at the ONS Congress, the authors noted that the preparation for VLDRT is the same as standard 24 Gy. They also referred to retrospective data from 1994 to 2017,4 which compared the early and late toxicities of patients who received standard vs VLDRT to nonorbital head and neck fields, which included the oral cavity, nasal cavity, salivary glands, sinuses, Waldeyer’s ring, and nodal disease.

The retrospective findings showed that the toxicities rates were significantly lower for the nonorbital head fields with VLDRT (n = 17) vs standard radiation (RT; n = 51) regarding dermatitis, xerostomia, dysgeusia, mucositis, esophagitis, site pain, anorexia, nausea, alopecia, dysphagia, and edema.

The findings were similar for the neck field for those who received VLDRT (n = 18) vs standard RT (n = 80); rates of dermatitis, xerostomia, esophagitis, dysphagia, hoarseness, mucositis, dysgeusia, alopecia, and nausea were all lower with 4 Gy.

Further patient benefits of VLDRT include “decreased time requirements for the patient to complete treatment, decreased disruption to patient/family life and work schedule, and decreased financial burden related to travel cost, child-care expenses, and potential loss of work for patient and/or family members,” the authors concluded in the poster.


  1. Adams C, Cho G, Yahalom J, et al. "Boom-Boom" very low dose, 2 fraction radiation therapy for the treatment of indolent non-Hodgkin lymphoma in the palliative setting. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P6.
  2. Lowry L, Smith P, Qian W, et al. Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: a randomised phase III trial. Radiother Oncol. 2011;100(1):86-92. doi:10.1016/j.radonc.2011.05.013.
  3. Hoskin PJ, Kirkwood AA, Popova B, et al. 4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non-inferiority trial. Lancet Oncol. 2014;15(4):457-63. doi: 10.1016/S1470-2045(14)70036-1.
  4. Chelius M, Chau K, Yang J, et al. Low grade, indolent lymphomas of the head and neck: Comparative toxicity of standard versus very low dose radiation therapy. Hematol Oncol. 2021;39(3):304-312. doi:10.1002/hon.2865
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