The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment

• Local radiotherapy is the standard therapy in limited-stage FL.
• We analyzed the value of chemotherapy in 130 patients with limited-stage FL.
• Similar results were observed in patients receiving chemotherapy or radiotherapy.
• Prospective trials are necessary to evaluate the addition of immunochemotherapy.

Local (involved-field or recently involved-site) radiotherapy is the standard therapy in limited-stage follicular lymphoma (FL). We retrospectively analyzed the value of chemotherapy in 130 patients with limited-stage FL (46 treated with radiotherapy alone [RT group], 30 with radiotherapy plus chemotherapy [COMBINED group] and 43 with chemotherapy alone [CHEMO group], 11 were managed with observation). Ninety-six percent of patients responded (RT 98%, COMBINED 100%, CHEMO 91%, p = 0.179), and 37% (40/107) of patients in complete response relapsed (RT 42%, COMBINED 27%, CHEMO 41%, p = 0.371). Progression-free survival (PFS) and overall survival (OS) probabilities at 10 years were similar in RT, COMBINED and CHEMO patients (PFS 41%, 61% and 39% [p = 0.167], and OS 77%, 81% and 72% [p = 0.821], respectively), while the COMBINED group showed a trend to better time-to-progression (TTP 43%, 72% and 47% [p = 0.055]). On multivariate analysis, only a FLIPI score ≥2 showed a trend to influence PFS (HR 2.1 [95% confidence interval 0.9–4.6], p = 0.067), and OS (HR 2.4 [0.9–6.5], p = 0.084), while patients treated with radiotherapy plus chemotherapy (COMBINED group) showed a significantly better TTP compared with those receiving only RT (HR 0.3 [0.1–0.8], p = 0.024). In our study no benefit was observed in survival with the use of systemic therapy compared with local radiotherapy.