Hyperfractionated Abdominal Radiation Is Safe and Feasible in the Treatment of B-Cell Lymphoma: A Single-Center Retrospective Cohort
Abdominal radiotherapy for B-cell lymphoma (BCL) is constrained by gastrointestinal and hematologic toxicity, owing to off-target effects within the field. Hyperfractionation via a smaller, twice-daily dose may limit toxicity while maintaining disease control. Abdominal radiation has emerging applications in both bridging and consolidation, but there is a paucity of data regarding the safety and feasibility of hyperfractionated abdominal radiation in BCL. Herein, we report a single-center experience of hyperfractionated radiation in BCL.
Materials and Methods/Case Presentation/Objective:
Patients with BCL who received any abdominal hyperfractionated radiation between September 2015 and March 2026 were included. The planned regimen was 25.6 Gy in 32 fractions (0.8 Gy/fraction) delivered twice daily by volumetric modulated arc therapy with involved-field boost variations. The primary endpoint was feasibility, defined as non-discontinuation. Treatment-related adverse events assessed from initiation through 14 days post-completion were graded by CTCAE v5.0, with baseline grade established using labs drawn within 8 weeks prior to RT initiation. Grade 3-4 adverse events were adjudicated for attribution to radiation, concurrent systemic therapy, or pre-existing organ dysfunction by chart review, then graded by CTCAE v5.0 from treatment initiation through 14 days post-completion. We restricted adverse event analysis to patients with complete laboratory values during the treatment period.
Results/Description/Main Outcome Measure(s):
Fourteen patients were included (median age 59 years, IQR 9; 11 male; 10 diffuse large B cell lymphoma, 1 Burkitt lymphoma 3 follicular lymphoma). Pre-RT PET Deauville score was 4.0 (IQR 2.0). Twelve out of fourteen patients completed the full radiation course. Two patients discontinued treatment: one due to tumor lysis syndrome and one due to grade 4 vomiting and syncope. Median clinical target volume was 2505 cc (IQR 2481), and 4 patients received boost RT. No new grade 4 hematologic adverse events occurred in any patients. Pre-existing gastrointestinal disease progressed in the patient who discontinued for vomiting and syncope. TLS co-occurred in the setting of R-CHOP. Eight patients went on to receive further treatment including autologous stem cell transplant and CAR-T therapy. Median overall survival was not reached and 9 patients were alive at last follow up.
Conclusion(s).:
Hyperfractionation to the abdomen is safe and feasible with tolerable side effects in the treatment of BCL. As a single-arm retrospective series, these hypothesis-generating findings warrant a prospective comparative study to evaluate the efficacy and survival benefit, and its role as a bridge to chimeric antigen receptor T-cell therapy and stem cell transplantation.
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