Although localized presentations are uncommon in non-Hodgkin lymphoma (NHL), the goal of treatment should be to cure the disease in patients who are shown to have truly localized occurrence after undergoing appropriate staging procedures.
Standard Treatment Options for Indolent, Stage I and Contiguous Stage II Adult NHL
Non-Hodgkin lymphoma is diagnosed by a tissue biopsy. If there is an enlarged, painless lymph node, without of an infection, a biopsy will be needed.
To perform a lymph node biopsy a doctor will cut into the lymph node to remove a sample of tissue or remove the entire lymph node. If the biopsy shows non-Hodgkin lymphoma, further testing will be needed to determine the specific type as well as to determine the stage of disease. Depending on your specific symptoms, the type of the lymphoma, its site...
Standard treatment options for indolent, stage I and contiguous stage II adult NHL include the following:
Rituximab with or without chemotherapy.
Other therapies as designated for patients with advanced-stage disease.
The National Lymphocare Study identified 471 patients with stage I follicular lymphoma. Of those patients, 206 were rigorously staged with a bone marrow aspirate and biopsy, and computed tomography (CT) scans or positive-emission tomography (PET-CT) scans. Nonrandomized treatments included radiation therapy (27%), rituximab-chemotherapy (R-chemotherapy) (28%), watchful waiting (17%), R-chemotherapy plus radiation therapy (13%), and rituximab alone (12%), although more than one-third of the patients started with expectant therapy. With a median follow-up of 57 months, progression-free survival favored R-chemotherapy or R-chemotherapy plus radiation therapy, but overall survival was nearly identical, all over 90%.[Level of evidence: 3iiiD] Clinical trials are required to answer questions such as:
If the PET-CT scan is clear after excisional biopsy, is watchful waiting or radiation therapy preferred?
Is there any role for R-chemotherapy plus radiation therapy?
Long-term disease control within radiation fields can be achieved in a significant number of patients with indolent stage I or stage II NHL by using dosages of radiation that usually range from 25 Gy to 40 Gy to involved sites or to extended fields that cover adjacent nodal sites.[3,4,5,6,7] Almost half of all patients treated with radiation therapy alone will relapse out-of-field within 10 years.
Rituximab with or without chemotherapy
For symptomatic patients who require therapy, when radiation therapy is contraindicated or when an alternative treatment is preferred, rituximab with or without chemotherapy can be employed (as outlined below for more advanced-stage patients). The value of adjuvant treatment with radiation to decrease relapse, plus rituximab (an anti-CD20 monoclonal antibody) either alone or in combination with chemotherapy, has been extrapolated from trials of patients with advanced-stage disease and has not been confirmed.[9,10]