Lymphomes malins non hodgkiniens |
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| Authors: | F Drouet X Cahu Y Pointreau F Denis M-A Mahé |
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| Institution: | 1. Service de radiothérapie du centre rené-gauducheau, CRLCC Nantes-Atlantique, Boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France;2. Service d’hématologie clinique CHU de Rennes, hôpital Pontchaillou, 2 rue Henri-Le-Guilloux 35033 Rennes cedex 9, France;3. Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan CHU de Tours, hôpital Bretonneau, 2, Boulevard Tonnellé 37000 Tours, France;4. Service de radiothérapie du centre Jean-Bernard, 9 rue Beauverger 72000 Le Mans, France;1. Inserm, UMRS 1018, institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France;2. Département d’oncologie médicale, institut de cancérologie de l’Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France;3. Centre universitaire de cancérologie Henry-s-Kaplan, CHU, 37000 Tours, France;4. Département de radiothérapie, institut de cancérologie de l’Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France;1. Institut Paoli-Calmettes, département d’hématologie, 232, boulevard Sainte-Marguerite, 13009 Marseille, France;2. Hôpital Saint-Louis, service d’hémato-oncologie, 1, avenue Claude-Vellefaux, 75010 Paris, France;1. CHU le Bocage, hématologie clinique, 14, rue Paul-Gaffarel, 21000 Dijon, France;2. Inserm umr1037, Cancer Research Center of Toulouse, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France;3. Inserm UMR866, faculté de médecine, 7, boulevard Jeanne-d’Arc, BP 27877, 21078 Dijon cedex, France;1. Département d’oncologie médicale, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France;2. Département d’oncologie et d’hématologie, centre hospitalier de la Dracénie, route de Montferrat, 83300 Draguignan, France;3. Département de médecine interne, gastroentérologie, cancérologie et rhumatologie, centre hospitalier d’Antibes Juan-les-pins, quartier la Fontonne, 107, avenue de Nice, 06606 Antibes cedex, France;4. Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France;1. Société française de radiothérapie oncologique, centre Antoine-Béclère, 45, rue des Saints-Pères, 75005 Paris, France;2. Pôle régional de cancérologie HS-Kaplan, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France;3. Université François-Rabelais, 37000 Tours, France;4. Institut de cancérologie de l’Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France;5. Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l’Hôpital, 67065 Strasbourg, France;6. Service de cancérologie et radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France;1. Service de pathologie Hôpital Louis-Pasteur 4, rue Claude-Bernard 28630 Le Coudray;2. Service d’anatomie-cytologie pathologique Institut Claudius-Regaud 20-24, rue Pont Saint-Pierre 31052 Toulouse cedex;3. Laboratoire de génétique Hôpital de la Source 14, av. de l’Hôpital – B.P. 86709 45067 Orléans cedex;4. Service d’anatomie-cytologie pathologique Hôpital de la Source 14, av. de l’Hôpital – B.P. 86709 45067 Orléans cedex |
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| Abstract: | With approximately 10000 cases per year in France, non-Hodgkin's lymphoma (NHL) represents the most frequent hematological malignancy, and 5 to 10 % of new cases of cancers. NHLs constitute a heterogeneous group of lymphoproliferative diseases, including entities with very different epidemiological and evolutive characteristics, as well as prognosis and treatments. Several classifications exist, but in practice, we individualize aggressive NHL including Diffuse Large B-Cell Lymphomas (DLBCL) which is the most common lymphoma, and indolent NHL including follicular lymphomas and mucosa-associated lymphoid tissue (MALT) lymphomas. The role of the radiotherapy in the management of NHLs varies according to the specific sub-type of lymphoma, but it has become increasingly limited over time. Overall it finds indications with curative intent only in situations of localized LMNH: either associated with chemotherapy as part of a combined modality therapy as for the treatment of localized DLBCL, or as exclusive treatment specially in the rare situations of localized follicular lymphomas. Moreover, lymphocytes being extremely radiosensitive cells, radiotherapy retains excellent indications with palliative intent for the management of symptomatic bulky tumor masses, and that whatever the sub-type of NHLs may be. It is important to remember that even today the «Involved Field» irradiation type remains the gold standard for the treatment of nodal NHLs, even if we witness at present the emergence of new types of irradiation, which aim to reduce the amount of irradiated tissues to try to limit the risks of delayed radio-induced complications. The purpose of this article is to clarify the specific aspects (epidemiological, radio-anatomical and prognostic characteristics) of each NHLs'sub-types (except primary central nervous system lymphomas), as well as the practical modalities of the irradiation (illustrated by a clinical case record) when an indication of radiotherapy is placed for their treatment. |
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