Radiation therapy has an important role in specific scenarios within indolent lymphoma subtypes:

• Early-stage FL (stage I and stage II in which lymph nodes are contiguous) is potentially curable with radiation Further adjuvant immunochemotherapy may confer additional progression-free survival
• In centres with radiation expertise, there may be a role for curative radiation therapy (total nodal irradiation) in a highly select group of patients with low-volume, advanced-stage disease
• Radiation therapy is appropriate in early-stage MZL (including gastric, cutaneous, unilateral and bilateral orbital MALT, and other localised MZLs) with potential curative intent. Note eradication of Helicobacter pylori infection should be performed first – it may induce remission without the need for radiation therapy in some cases
• In localised relapse of low-grade lymphomas, it may defer the need for systemic immunochemotherapy
• It may be used for symptom control in advanced-stage low-grade lymphomas, where lymphoma is impairing quality of life.

Timeframe for starting treatment

Begin within four weeks, as prioritised by a multidisciplinary team decision (see 3.4 Treatment planning). Start earlier for life- or organ-threatening indications. Delaying radiation therapy (e.g. for further monitoring) may cause distress and should be discussed with the patient.

Training and experience required of the appropriate specialists

Fellow of the Royal Australian and New Zealand College of Radiologists or equivalent, with adequate training and experience, institutional credentialing and agreed scope of practice in lymphoma management.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management