Background
Retrospective single-institution analysis (Yale University) of primary cutaneous B-cell lymphoma (PCBCL) treated with radiation therapy. Study compared tumor classification under EORTC vs. WHO systems and analyzed RT outcomes. Patients had primary cutaneous follicle center lymphoma (PCFCL), cutaneous marginal zone lymphoma (PCMZL), or diffuse large B-cell lymphoma, leg type (PCDLBCL-LT).
Interventions and follow up
Arm A: Radiation therapy as primary treatment for PCBCL
Arm B: N/A — single-arm retrospective; EORTC vs. WHO classification compared
Primary endpoint: Disease-specific survival, relapse-free survival by histologic subtype and classification system
mFollow up: Not specified
Arm B: N/A — single-arm retrospective; EORTC vs. WHO classification compared
Primary endpoint: Disease-specific survival, relapse-free survival by histologic subtype and classification system
mFollow up: Not specified
Results
PCFCL/PCMZL (indolent types): Excellent outcomes with RT; local control ~90–100%
PCDLBCL-LT: Inferior outcomes; higher systemic progression rate
EORTC vs. WHO classification: Prognostic stratification differed between systems; EORTC better segregated low- from high-risk disease in this cohort
RT efficacy: High local control rates for indolent PCBCL with involved-field RT
PCDLBCL-LT: Inferior outcomes; higher systemic progression rate
EORTC vs. WHO classification: Prognostic stratification differed between systems; EORTC better segregated low- from high-risk disease in this cohort
RT efficacy: High local control rates for indolent PCBCL with involved-field RT
Adverse events
Main adverse events: RT well tolerated for localized PCBCL. Acute skin reactions and fatigue expected with involved-field RT. No grade 4 toxicities reported in this retrospective series.
Conclusions
RT is highly effective for indolent PCBCL (PCFCL and PCMZL), with excellent local control. PCDLBCL-LT has inferior outcomes and requires systemic therapy. Classification system choice (EORTC vs. WHO) has practical implications for prognostic stratification.
Key Limitations
Key Limitations: Retrospective; small sample size limiting subgroup analysis; lack of standardized RT doses; pre-2004 classification systems differ from current WHO classification; limited follow-up duration.
Clinical Context
Seminal early paper establishing RT as standard of care for indolent PCBCL. Current practice (per NCCN/ESMO): involved-field RT 24–30 Gy for PCFCL/PCMZL; PCDLBCL-LT treated as systemic DLBCL with R-CHOP ± RT. Low-dose RT (4 Gy × 2) increasingly used for palliation of indolent PCBCL (see Akhtari MDACC series).
References
References: Smith BD et al, JCO 2004 (Yale PCBCL outcomes)