Objectives

The aim of the study was:

• To determine whether 15 Gy mediastinal radiation was necessary in the treatment of T cell leukaemia/ lymphoma.

Figure 9.5 Treatment schema: T cell protocol. ADR: adriamycin (doxorubicin); ASP: asparaginase; CF: folinic acid; CYP: cyclophosphamide; MTX: methotrexate; PRFD: prednisone; RT: radiotherapy; TG: thioguanine; VCR: vincristine. Adapted from Mott et al. (full reference on p. 172) with permission from Nature, Macmillan Publishers Ltd.

Figure 9.5 Treatment schema: T cell protocol. ADR: adriamycin (doxorubicin); ASP: asparaginase; CF: folinic acid; CYP: cyclophosphamide; MTX: methotrexate; PRFD: prednisone; RT: radiotherapy; TG: thioguanine; VCR: vincristine. Adapted from Mott et al. (full reference on p. 172) with permission from Nature, Macmillan Publishers Ltd.

Figure 9.6 FFS for T lymphoma patients randomized with or without mediastinal radiation (RT). Adapted from Mott et al. (full reference on p. 172) with permission from Nature, Macmillan Publishers Ltd.

mediastinal radiation. There was a highly significant difference in favor of those randomized to receive radiation (FFS 66% versus 18%, p = 0.01) (Figure 9.6).

The difference remained significant when patients with T leukemia were included (FFS 51% versus 21%, p = 0.01).

Conclusion

Review of the first adverse events showed that the major differences in the two arms of the trial were in the frequency of spread to the bone marrow and/or CNS, and in the late occurrence of relapse in the non-irradiated patients. There were three patients randomized to receive radiation before completion of induction who then had early adverse events, but even when these patients were excluded from the analysis the difference between the two arms of the trial remained significant. It is suggested by the authors that the benefit observed from radiation would not have been seen if given in conjunction with more effective systemic chemotherapy.

A second paper describes all 120 children with T and B NHL in the same study showing no difference for non-mediastinal primary disease.

Mott MG, Eden OB, Palmer MK. Adjuvant low dose radiation in childhood non-Hodgkin's lymphoma. Br J Cancer 1984;50:463-9.

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