Although localized presentations are uncommon in non-Hodgkin lymphoma (NHL), the goal of treatment should be cure of the disease in patients who are shown to have truly localized occurrence after undergoing appropriate staging procedures. 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.[1,2,3,4] The value of adjuvant chemotherapy (single-agent chlorambucil or doxorubicin-based combination chemotherapy), in addition to radiation to decrease relapse, has not been proven conclusively.[5,6]

When radiation therapy is contraindicated, chemotherapy can be employed for symptomatic patients (as outlined below for more advanced-stage patients), or watchful waiting can be considered for asymptomatic patients.[7]

Patients with involvement not encompassable by radiation therapy are treated as outlined for patients with stage III or stage IV low-grade lymphoma. Follicular large cell and mantle cell NHL are often treated as aggressive lymphomas (nodal and extranodal presentations).

STANDARD TREATMENT OPTIONS:

1. Involved-field radiation therapy.[1,2,3,4]
2. Watchful waiting.[7]
3. Chemotherapy with radiation therapy.[6]
4. Extended (regional) radiation therapy to cover adjacent prophylactic nodes.[1,2,3,4,8]
5. Rituximab, an anti-CD20 monoclonal antibody, either alone or in combination with chemotherapy and extrapolated from trials of patients with advanced-stage disease.
6. Other therapies as designated for patients with advanced-stage disease.

References:

1. Mac Manus MP, Hoppe RT: Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University. J Clin Oncol 14 (4): 1282-90, 1996.
2. Vaughan Hudson B, Vaughan Hudson G, MacLennan KA, et al.: Clinical stage 1 non-Hodgkin's lymphoma: long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy. Br J Cancer 69 (6): 1088-93, 1994.
3. Denham JW, Denham E, Dear KB, et al.: The follicular non-Hodgkin's lymphomas--I. The possibility of cure. Eur J Cancer 32A (3): 470-9, 1996.
4. Haas RL, Poortmans P, de Jong D, et al.: High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas. J Clin Oncol 21 (13): 2474-80, 2003.
5. Kelsey SM, Newland AC, Hudson GV, et al.: A British National Lymphoma Investigation randomised trial of single agent chlorambucil plus radiotherapy versus radiotherapy alone in low grade, localised non-Hodgkins lymphoma. Med Oncol 11 (1): 19-25, 1994.
6. Seymour JF, Pro B, Fuller LM, et al.: Long-term follow-up of a prospective study of combined modality therapy for stage I-II indolent non-Hodgkin's lymphoma. J Clin Oncol 21 (11): 2115-22, 2003.
7. Advani R, Rosenberg SA, Horning SJ: Stage I and II follicular non-Hodgkin's lymphoma: long-term follow-up of no initial therapy. J Clin Oncol 22 (8): 1454-9, 2004.
8. Ha CS, Kong JS, Tucker SL, et al.: Central lymphatic irradiation for stage I-III follicular lymphoma: report from a single-institutional prospective study. Int J Radiat Oncol Biol Phys 57 (2): 316-20, 2003.