Some Types of Non-Hodgkin Lymphoma Treatable With “Boom-Boom” Radiation

“In general, we like to think of indolent versus more aggressive lymphomas,” she says. Aggressive lymphomas such as diffuse large B-cell lymphoma grow quickly and need more intense treatment to stop them from spreading. Indolent lymphomas are much slower growing, so doctors approach them with a different treatment strategy. Radiation is often part of the treatment plan — and sometimes it’s the only treatment needed.

“For indolent lymphomas like follicular lymphoma or marginal zone lymphoma, radiation can be effective with only two doses of treatment,” Dr. Pinnix says. Radiation offers good results with fewer side effects than chemotherapy. And for early-stage cancers that are confined to a small area of the body, radiation can cure the disease, even when given at low doses.

“Boom-Boom”

Doctors once gave their patients high doses of radiation in the hope that it would produce a greater response. Yet there has been a shift in recent years away from high-dose radiation to much lower doses. Doctors measure radiation in units called Gy (pronounced “gray”), which represents the total amount of radiation a person’s tissues absorb from treatment. The dose is further divided into units known as fractions.

For a patient with an indolent non-Hodgkin lymphoma, typically the doses used are 24 Gy for standard treatment and 4 Gy/2 fractions for palliation (symptom control), Dr. Pinnix explains. Doctors affectionately refer to the 4Gy/2 fraction dose by the nickname “boom-boom.”

In the past, people with certain indolent lymphomas — including indolent orbital lymphomas — were treated with doses as high as 40 to 50 Gy. “There’s an interesting story behind the 4 Gy/2 fractions,” Dr. Pinnix says. “A patient in France reportedly had an indolent lymphoma that was scheduled for therapy, and he only went for two treatments and decided he didn’t want to continue.” When the patient came back a few months later, his doctors noticed that his lymphoma was gone. The smaller dose of radiation had effectively cured him.

“And so that launched this interest in very low-dose treatment,” she says. “Now we’re giving 4 Gy with great results.”

Is This Radiation Strategy Right for You?

The “boom-boom” strategy is used for people who have indolent lymphomas such as follicular lymphoma, marginal zone lymphoma, mantle cell lymphoma, or MALT lymphoma, to shrink areas of disease that are causing symptoms. The smaller dose is designed to treat the cancer without causing unnecessary side effects. It also helps patients get through their treatment faster. “Just two days of treatment can be effective,” Dr. Pinnix tells SurvivorNet.

She says there are studies going on at MD Anderson Cancer Center looking at radiation doses of 4Gy and 2 fractions as the only treatment for people with orbital MALT — a cancer that forms in the eye. “We’ve almost finished recruiting and the responses have been excellent. More than 88% of patients have a complete response to just two fractions of treatment,” Dr. Pinnix says.

 

Reviewed by Dr. Sairah Ahmed, associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center

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