ESTRO 2020

Session Item

August 02
08:45 - 10:00
Optimal treatment for periorificial high risk non-melanoma skin cancer
23:00 - 23:00
Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients


Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients
Authors: Galunic Bilic|, Lea(1)*[];Santek|, Fedor(1);Soce|, Majana(1);Grah|, Josip J(2);Basic Kinda|, Sandra(3);Radman|, Ivo(3);Mitrović|, Zdravko(4);Martinović|, Marko(5);Aurer|, Igor(3);
(1)University Hospital Center Zagreb, Department of oncology and radiotherapy, Zagreb, Croatia;(2)Univ. Klinik für Strahlentherapie-Radioonkologie- LKH Graz, Department for radiotherapy, Graz, Austria;(3)University Hospital Center Zagreb, Department of hematology, Zagreb, Croatia;(4)University Hospital Dubrava, Department of hematology, Zagreb, Croatia;(5)University Hospital Merkur, Department of hematology, Zagreb, Croatia;
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Purpose or Objective

Most studies of radiotherapy in lymphoma were performed in supradiaphrgamatic localizations. Data on efficacy and toxicity of irradiation of infradiaphragmatic fields are scarce. We therefore performed this retrospective study to analyze our experience with lymphoma patients receiving radiotherapy exclusively to infradiaphragmatic fields.

Material and Methods

We identified 112 patients treated with external beam radiotherapy between January 2003 and December 2014. The median follow-up for all patients is 51 months (range 1-185 months). There were 69 patients irradiated with 2D technique and 43 using 3D conformal radiotherapy (3DCRT). Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy. Data for long-term side effects were available for 80 patients.


Five and 10-year overall survival (OS) rates were 69% and 58% respectively and 5 and 10-year event-free survival rates (PFS) 59% and 57% for all patients. The in-field and out-of-field recurrence rates were 5% and 21%. Patients with indolent NHL had 5 and 10-year OS rates of 84% and 63% respectively, and 5 and 10-year EFS rates of 54% and 48%. In patients with aggressive NHL 5 and 10-year OS was 75% and 64% respectively and 5 and 10-year EFS 65% and 65%. OS and EFS was significantly better in the group of patients that were irradiated after one line than after two or more lines of chemotherapy (5-years OS 87% vs. 68%, p =0.001 and EFS 72% vs. 28%, p <0.001). Acute toxicity occurred in 43% patients; gastrointestinal in 26% and hematological in 15%. 2D radiotherapy resulted in more hematologic toxicity than 3D conformal (31% vs. 7%, p= 0.007). Nausea occurred in 10% patients in 2D group and in 28% patients in 3D group (p= 0.020). Long-term side effects were noted in 15% of patients; gastrointestinal in 5%, renal in 4% and secondary malignancy in 2%; there was no significant difference between patients irradiated using 2D and 3D technics. 


Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. The difference in toxicity between older and newer radiation technics seems less pronounced than for supradiaphragmatic fields. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy.