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. 2024 Jan 10;31(1):383-393.
doi: 10.3390/curroncol31010025.

Hypofractionated Radiotherapy for Hematologic Malignancies during the COVID-19 Pandemic and Beyond

Febin Antony  1 , Arbind Dubey  1 , Pamela Skrabek  2 , Lung Fung Tsang  3 , Pascal Lambert  3 , Bohdan Bybel  4 , Naseer Ahmed  1   5
Affiliations

Hypofractionated Radiotherapy for Hematologic Malignancies during the COVID-19 Pandemic and Beyond

Febin Antony et al. Curr Oncol. .

Abstract

Purpose: Radiotherapy is integral in the management of hematological malignancies (HM). Standard radiotherapy dose fractionation regimens range between 20 and 50 Gy in 10-25 fractions over 2-5 weeks. This study presents the outcomes of patients with HM treated with hypofractionation radiotherapy (HFRT) during the COVID-19 pandemic.

Methods: Patients (n = 36) were treated with HFRT between January 2020 and September 2022. The outcomes measured were the overall response rate (ORR), freedom from local progression (FFLP), and overall survival (OS).

Results: The median follow-up was 13.2 months. Thirty-three patients (92%) had non-Hodgkin (NHL) or Hodgkin lymphoma (HL). Eighteen patients (50%) had aggressive and nine (25%) had indolent NHL. Nineteen patients (53%) presented with stage I/II and fifteen (42%) with stage III/IV disease. Twenty-five (69.4%) and eleven (30%) received consolidative and definitive RT, respectively. Twenty patients (56%) received treatment to the neck and/or thorax and nine (25%) to the abdomen or pelvis. The total dose ranged from 18 to 42.5 Gy in 6-17 fractions/2.67-5 Gy per fraction. The median dose in 2 Gy fractions for an alpha/beta (α/β) ratio of 10 amounted to 39 Gy (SD ± 13.86) and 43.6 Gy (SD ± 12) for an α/β of 3. The most commonly used fractionation scheme was 39 Gy in 13 fractions. ORR was 94.4% for the entire cohort, and 100, 94.4, and 83.3% for indolent NHL, aggressive NHL, and HL patients. The two-year FFLP was 76% (95% CI: 34-93%) for the entire cohort and 100, 87 (95% CI: 56.4-96.5%), and 42% (95% CI: 1.1-84.3%) for the indolent NHL, aggressive NHL, and HL patients. Two-year OS for the entire cohort was 80% (95% CI: 59.9-90.5%) and 100, 66.1 (95% CI: 36.4-84.4%), and 100% for the indolent NHL, aggressive NHL, and HL patients. Only one patient presented with grade two pulmonary toxicity.

Conclusions: HFRT in HM provides excellent local control to be validated in a larger prospective study.

Keywords: hypofractionation; lymphomas; radiotherapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Relative frequency of dose fractionation schedules. The most commonly used fractionation scheme was 39 Gy in 13 fractions (highlighted in red). Size of each circle represents the relative number of patients treated with a particular dose fractionation scheme.
Figure 2
Figure 2
Freedom from local progression (FFLP) of the entire patient cohort (n = 36).
Figure 3
Figure 3
Freedom from local progression (FFLP) based on histopathological diagnosis.
Figure 4
Figure 4
Two years overall survival of the entire patient cohort treated with hypofractionated radiotherapy (n = 36).
Figure 5
Figure 5
Two-year overall survival based on histopathological diagnosis.
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