Good things come in small packages: low-dose radiation as palliation for indolent non-Hodgkin lymphomas

Numerous management options are available to patients with advanced-stage or relapsed/refractory indolent non-Hodgkin lymphomas (NHLs). These include observation in patients with low-volume disease, systemic therapy including radioimmunotherapy, and high-dose therapy with stem cell transplant. In selected patients with localized symptomatic disease, local radiation therapy to sites of involvement can offer effective palliation. However, systemic therapy and standard-dose radiation therapy can be associated with significant toxicities. Over the past 15 years, several groups have investigated the role of low-dose radiation therapy - typically 4 Gy in two fractions - to an involved-field as an option for palliation in patients with NHL. Overall response rates of more than 80% have been consistently reported with local control maintained for 2 years. In this review, we outline the clinical experience with this approach in NHL of various histologies.