Very Low Dose Radiation for FL

Interesting research presented recently at the 47th Annual Oncology Nursing Congress. I haven't seen the actual research or an abstract, but Onc Live has a nice write up about it. The presentation had the excellent title of "Boom-Boom" Very Low Dose, 2 Fraction Radiation Therapy for the Treatment of Indolent Non-Hodgkin Lymphoma in the Palliative Setting."

How could I resist a presentation at a medical conference with a title that starts with "Boom-Boom"?

The "boom boom" actually refers to two doses of radiation given to patients with indolent NHL (that is, slow-growing lymphomas like Follicular Lymphoma). A reminder, for those who need it:

Some FL patients who have stage 1 or stage 2 disease can be treated (and maybe even cured, in some cases) with standard radiation. Unfortunately, only about 15 or 20% of FL patients are diagnosed with stage 1 or 2 disease. Symptoms just don't show up very clearly at that early stage, so most people are diagnosed accidentally, maybe when they having surgery for something else. Standard radiation works because the disease is located in one or two areas. That makes it easier for a beam of radiation to be aimed. It's a treatment that can work really well for some patients.

This research tested whether or not a very small amount of radiation can do the job -- just 2 doses, rather than the 12 doses that are typical. And the result is that yes, it seems to work for many patients. More importantly, when it doesn't work, another treatment can be started immediately, so the patient isn't put in too much danger. 

And just as importantly, Quality of Life is increased. If you've ever had radiation treatment or know someone who has, you know it's a grueling process, taking a long time and a lot of energy from the patient, with nasty side effects. Fewer doses means less of all of that.

What I find so interesting isn't so much the research results themselves, though it's great for the patients who will benefit from it. What's more interesting for me is that it fits into a pattern. A small pattern, but an important one -- more attention being paid to using as little treatment as possible to get the best results. It's an attitude that prioritizes patient safety and Quality of Life while still valuing effectiveness.

It matters to me because it's the approach that my first oncologist took. He recommended Rituxan, rather than something like R-CHOP, because he wanted to do as little harm as possible. And for me, it worked. 

Here, the research basically asks, "What is the least treatment we can give and still have the best outcome?" So if 12 works, how will 8 doses work? Or 4? or maybe 2?

It makes me think, too, about the controversy about PI3K inhibitors. The FDA is asking makers of those treatments to pay more attention to dosing -- to basically ask, "Can we give less of those treatment to patients, so we have similar effectiveness with fewer side effects?" 

I'm still waiting for abstracts for ASCO, which is happening in a few weeks, but I have been able to see titles. And one title that caught my eye suggests that lower doses of Rituxan, and just a little Rituxan maintenance, can be very effective with fewer side effects.

See the pattern? 

It's almost like the Lymphoma Community is saying "We have a bunch of things that work well. How can we make them work even better?"

I'll be looking for this pattern as I start to go through ASCO abstracts, to see if it's just these few instances, or if it's some bigger movement in the community. 

It certainly would an excellent thing, especially since many of us can expect multiple treatments during a long life.