Haematology: Follicular lymphoma: low-dose palliative RT (4 Gy / 2 fractions)

Why C is correct

The FORT trial compared 4 Gy in two fractions with 24 Gy in 12 fractions for indolent lymphoma. Although 24 Gy gave superior local control and is the curative-intent standard, the trial concluded that 4 Gy remains a useful alternative for palliative treatment. In a frail, heavily pre-treated patient where the aim is rapid symptom relief with minimal burden, 4 Gy in two fractions is the appropriate low-dose palliative schedule.

And why the others are not

• AIncorrect: 40-45 Gy is a historical high dose shown to be unnecessary even for cure, and is inappropriate for palliation.
• BIncorrect: 24 Gy in 12 fractions is the curative-intent standard dose, more than is needed and more burdensome for pure palliation in a frail patient.
• DIncorrect: 30 Gy in 15 fractions exceeds the indolent-lymphoma curative dose and is not a validated low-dose palliative schedule.
• EIncorrect: 8 Gy single fraction is a bone-metastasis/myeloma palliative schedule, not the FORT-validated indolent-lymphoma palliative regimen.

Source FORT - 4 Gy versus 24 Gy radiotherapy for indolent lymphoma — Hoskin PJ, Kirkwood AA, Popova B, et al. 4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non-inferiority trial. Lancet Oncol. 2014;15(4):457-463.