A multicenter, retrospective study recently published in 2019 in Blood demonstrated that patients with stage I or stage II follicular lymphoma (FL) as indicated by fluorine-18 fludeoxyglucose positron emission tomography 18F-FDG PET/CT who received contemporary radiation therapy (RT) experienced higher rates of freedom from progression (FFP) and overall survival (OS) compared with historical series.1

Richard T. Hoppe, MD, a radiation oncologist at Stanford Cancer Center in Palo Alto,California, and an author of the study, told Cancer Therapy Advisor that, for patients with stage I or stage II FL, it is his hope that “this paper will generate more awareness that RT is not only very effective, but it’s safe.”

Accurate staging of FL is critical because the treatment of early-stage disease differs substantially from that of later-stage disease.2 The National Comprehensive Cancer Network (NCCN) recommends involved-site radiation therapy (ISRT) as initial therapy for stage I and stage II non bulky FL, whereas symptomatic,later-stage disease indicating a need for treatment include rituximab-based systemic multiagent regimens.1

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For early-stage FL, the recommended initial therapy is RT, although this has not been widely adopted. Because nodal involvement is critical for staging, imaging is an important component of the workup for FL. Missed identification of any involved nodes could result in a lower-stage assignment, and thus, inadequate treatment. It is hypothesized that more accurate staging results in improved FL outcomes by identifying which patients should receive RT for early-stage disease compared with systemic therapy for symptomatic later-stage disease.