Lower Radiation Dose Spares Patients From Experiencing Side Effects Without Compromising Outcomes in Rare Lymphoma

Certain patients with orbital indolent B-cell lymphoma — a rare type of blood cancer that occurs in the eye — may be able to bypass high doses of radiation, sparing them from unwanted side effects and the time and financial commitments of longer-term cancer treatment, according to recent phase 2 trial findings.

The study involved 50 patients with stage 1 or 2 indolent B-cell lymphoma who received a lower dose of radiation than the current standard of care. Patients were then monitored at three-month intervals, and those who did not have a complete response (meaning that their disease completely disappeared) then received the remaining doses of radiation that would bring them up to the current standard.

However, for the majority of patients, the low-dose radiation was enough to control their disease.

Forty-four of the 50 patients involved in the study experienced a complete response from the lower dose. Six patients qualified for receiving the higher dose, but only two received it — the others either refused further treatment and opted for continued monitoring or went on to receive systemic (throughout-the-body) treatments.

“We found that this approach can really spare many patients a standard dose of radiation,” study author Dr. Chelsea Pinnix, an associate professor of radiation oncology at The University of Texas MD Anderson Cancer Center in Houston, said in an interview with CURE®. “We saw excellent control that we’ve observed over three years of follow-up.”

There were no severe side effects seen on the clinical trial, and three patients (6%) experienced grade 1 (mild) dry eye, which meant that an intervention, such as eye lubricants, were needed.

In addition to saving patients from potential side effects, the lower radiation dose also was less time-intensive than the standard dose, Pinnix explained, noting that this could also decrease the financial effect of undergoing cancer treatment.

“When patients receive radiation treatment, there’s typically daily treatments. For most patients, it’s over the course of several weeks,” Pinnix said. “For the (standard) course, it’s usually two and a half weeks (where patients need) daily treatment.”

The lower dose, however, can be administered over the course of a few days, and has now become the standard of care at MD Anderson for eligible patients with orbital indolent B-cell lymphoma.

“Sometimes patients travel to different centers to receive radiation. They may incur hotel costs, and pay for gas going back and forth, as well as take time off work,” Pinnix said. “So patients are really enthusiastic about the fact that they can come in, have their treatment planning occur and then get two days of back-to-back treatment and everything can be done over the course of a few days.”

Pinnix noted that some patients may feel apprehensive about not getting the full dose of radiation, because they may think that it would put them at a higher risk for relapse. However, she emphasized that orbital lymphoma tends to be a slow-growing disease. In fact, she recalls that most patients experience symptoms for months — or even years — before receiving their diagnosis, and the disease is oftentimes still contained to the eye area.

Ultimately, Pinnix recommended that patients have open conversations with their health care providers to determine which treatment plan is right for them.

“I encourage patients to ask their providers about what their options are,” Pinnix said. “As we continue to publish more about (the lower-dose approach), people become more familiar with it and we have other (cancer) centers that are publishing their results and outcomes, I think that it will provide a lot of assurance.”

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