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Haematology: Stage I follicular lymphoma: curative-intent RT dose

Free question published 20 September 2026

HaematologyStage I follicular lymphoma: curative-intent RT dose

A 56-year-old man presents with a single enlarged inguinal node. Excision biopsy shows grade 1 follicular lymphoma. Staging PET-CT and bone marrow confirm localised stage IA disease with no other sites. He is fit and treatment is curative in intent. What is the most appropriate radiotherapy approach?

  1. AInvolved-site radiotherapy to 24 Gy in 12 fractions
  2. BInvolved-site radiotherapy to 4 Gy in 2 fractions
  3. CWhole-abdomen radiotherapy to 30 Gy
  4. DNo radiotherapy; immediate R-CHOP immunochemotherapy
  5. EExtended-field radiotherapy to 40 Gy in 20 fractions

Why A is correct

For localised (stage I-II) follicular lymphoma, radiotherapy alone is the curative-intent treatment of choice, and the recommended dose for most cases is 24 Gy, delivered as involved-site radiotherapy. This is supported by the FORT trial (24 Gy superior to 4 Gy for local control) and consistent with ESMO and ILROG guidance.

And why the others are not

  • BIncorrect: 4 Gy in two fractions is a palliative low-dose schedule, not the curative dose for localised follicular lymphoma.
  • CIncorrect: whole-abdomen radiotherapy is not indicated for a single localised inguinal node and carries excess toxicity.
  • DIncorrect: immunochemotherapy is reserved for advanced or high-tumour-burden disease; localised stage I follicular lymphoma is managed with curative radiotherapy.
  • EIncorrect: extended-field 40 Gy reflects obsolete large-volume, high-dose technique; modern practice uses reduced-volume ISRT at 24 Gy.

Source Radiotherapy of follicular lymphoma - curative dose and low-dose palliation — Yahalom J. Radiotherapy of Follicular Lymphoma: Updated Role and New Rules. Curr Treat Options Oncol. 2014;15(2):262-268.

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