Strahlentherapie und Onkologie

, Volume 194, Issue 5, pp 454–461 | Cite as

Response rates and recurrence patterns after low-dose radiotherapy with 4 Gy in patients with low-grade lymphomas

  • Laila König
  • Juliane Hörner-Rieber
  • Denise Bernhardt
  • Adriane Hommertgen
  • Stefan Rieken
  • Jürgen Debus
  • Klaus Herfarth
Original Article



Retrospective study of effectiveness, toxicity, and relapse patterns after low-dose radiotherapy (LDRT) in patients with low-grade lymphomas.


47 patients (median age 64 years) with 50 lesions were treated with LDRT (2 × 2 Gy). In 60%, LDRT was the primary and curative treatment, in 40% offered as second-line therapy in recurrent disease. Histology included follicular (57%) and marginal zone lymphomas (43%). Patients were followed-up regularly clinically (skin) and with CT or MRI scans.


Median follow-up was 21 months. 84% of the lesions were extranodal disease (32% orbit, 14% salivary glands, 30% skin, and 8% others). Most lesions were ≤5 cm (90%) with a singular affection (74%). 26% of the patients received rituximab simultaneously. Overall response rate (ORR) was 90% (all lesions), 93.3% (primary treatment), and 85% (recurrence treatment); p = 0.341. 2‑year Local progression-free survival (LPFS) for all, curative, and palliative patients was 91.1%, 96.7%, and 83.8%, respectively; p = 0.522. Five relapses were detected: three infield only, and were therefore treated with LDRT or subsequent local RT of 30 Gy. Two patients showed an in- and outfield progression and were consequently treated with chemotherapy. Predictive factors for higher LPFS were tumor size ≤5 cm (p = 0.003), ≤2 previous treatments (p = 0.027), no skin involvement (p = 0.05), singular affection (p = 0.075), and simultaneous rituximab application (p = 0.148). LDRT was tolerated well, without detectable acute or long-term side effects.


Primary LDRT is an effective treatment with high ORR and long-lasting remissions in a subset of patients with low-grade lymphoma, and may therefore be a curative treatment option for patients with low tumor burden. LDRT with the CD20 antibody obinutuzumab will soon be tested in a prospective multicenter trial.


2 × 2 Gy Low-grade Non-Hodgkin lymphoma Treatment outcome Local progression-free survival Rituximab 

Ansprechraten und Rezidivmuster nach Niedrigdosis-Bestrahlung mit 4 Gy bei Patienten mit indolenten Lymphomen



Retrospektive Analyse zur Erfassung von Effektivität, Nebenwirkungen und Rezidivmuster nach Niedrigdosis-Bestrahlung (LDRT) von Patienten mit indolenten Lymphomen.


Ausgewertet wurden 47 Patienten mit 50 Läsionen (medianes Alter 64 Jahre), die mittels LDRT (2 × 2 Gy) bestrahlt wurden. Die LDRT wurde bei 60% als primäre und kurativ-intendierte Therapie durchgeführt, bei 40% in der Rezidivsituation im palliativen Ansatz. In 57% der Fälle handelte es sich um follikuläre und in 43% um Marginalzonenlymphome. Die Patienten wurden nach LDRT regelmäßig klinisch (Hautbefall) und mittels Computertomographie oder Magnetresonanztomographie nachbeobachtet.


Das mediane Follow-up betrug 21 Monate. Bei 85% der Läsionen lag eine extranodale Manifestation vor (32% Orbita, 14% Speicheldrüsen, 30% Haut, 8% andere Organe). Meist waren die Läsionen klein (≤5 cm, 90%) und mit singulärem Befall (74%). Eine simultane Rituximab-Gabe erhielten 26% der Patienten. Die Ansprechrate nach LDRT war mit 90% (alle Läsionen), 93,3% (Primärsituation) und 85% (Rezidivsituation) hoch (p = 0,341). Das lokale progressionsfreie 2‑Jahres-Überleben für alle, kurativ und palliativ behandelte Patienten betrug 91,1%, 96,7% und 83,8% (p = 0,522). Insgesamt wurden 5 Rezidive detektiert: 3 befanden sich im Bestrahlungsfeld und wurden entweder erneut mittels LDRT oder mit einer Dosisaufsättigung von 30 Gy therapiert. Bei 2 Patienten zeigte sich ein generalisierter Progress der gesamten Erkrankung, sodass eine systemische Therapie initiiert wurde.


Die primäre LDRT ist eine effektive Behandlung mit hohen Ansprechraten und anhaltenden Remissionen und kann bei einer Subgruppe von Patienten mit indolenten Lymphomen auch als kurativer Ansatz angeboten werden. LDRT mit dem CD20-Antikörper Obinutuzumab wird zukünftig in einer prospektiven, multizentrischen Studie untersucht.


2 × 2 Gy Indolente Non-Hodgkin Lymphome Behandlungserfolg Lokales Progressionsfreies Überleben Rituximab 



This work was supported by the Medical Faculty of Heidelberg University providing a research grant for LK .

Compliance with ethical guidelines

Conflict of interest

L. König, J. Hörner-Rieber, D. Bernhardt, A. Hommertgen, S. Rieken, J. Debus, and K. Herfarth declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The analysis was approved by the ethics committee of our institution (S-368/2017). Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany

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