Lymphoma
2026-05-22
EORTC cutaneous lymphoma RT recommendations
TL;DRReduced-dose RT recommended across indolent cutaneous lymphomas; local MF lesions 8-12 Gy in 2-3 fx, 1-yr local control ≥92%, no randomized evidence.
The de-escalation is not uniform: 4 Gy is endorsed for CD4+ small/medium T-cell LPD and many pcFCL/pcMZL, but gave inferior MF local control and worse outcomes in B-cell lesions >5 cm. The algorithm handles this with response-adapted escalation to cumulative 24 Gy rather than upfront conventional dosing. The longer read
The de-escalation is not uniform: 4 Gy is endorsed for CD4+ small/medium T-cell LPD and many pcFCL/pcMZL, but gave inferior MF local control and worse outcomes in B-cell lesions >5 cm. The algorithm handles this with response-adapted escalation to cumulative 24 Gy rather than upfront conventional dosing.
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Expert opinion from the EORTC cutaneous lymphoma tumour group, summarizing retrospective series and small prospective cohorts into a dose algorithm (Figs 2A/2B). No new patient data.
MF local lesions 8-12 Gy in 2-3 fx; low-dose TSEBT 8-12 Gy for palliation, up to 24 Gy before autologous SCT. CD4+ small/medium T-cell LPD 4 Gy in 2 fx; pcFCL/pcMZL start at 4 Gy with escalation to cumulative 24 Gy for residual disease or local failure.
Moves away from conventional 30-40 Gy, the standard until about 20 years ago, and builds on prior EORTC consensus treatment-selection recommendations. The 4 Gy question in cutaneous B-cell disease remains contested between small series and a long-f/u registry analysis.
Supporting series use varied endpoints (ORR, CR, local relapse, DOR, TTNT) and heterogeneous fractionation, so cross-series comparison is loose. QoL data after modern doses are sparse.
Low-dose local RT gives rapid symptom relief with low toxicity and few local relapses, but low-dose TSEBT relapses are common. Authors call for a prospective randomized dose trial with translational endpoints, and combined-modality work in advanced MF, SS and DLBCL leg type.
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