FoRT
FoRT asked whether two very small doses of radiotherapy control follicular lymphoma as well as the standard twelve; they do not, with about three times the rate of regrowth in the treated area, so 24 Gy stays the standard when the aim is lasting control and 4 Gy is kept for palliation.
Overview
FoRT was a UK phase 3 non-inferiority trial that randomised 614 target sites in 548 patients with follicular or marginal zone lymphoma to 24 Gy in 12 fractions or 4 Gy in 2 fractions. The primary endpoint was time to local progression within the irradiated volume; the trial allowed both curative-intent and palliative treatment.
At the first report 4 Gy failed non-inferiority, with a hazard ratio of 3.42 for local progression. Long-term follow-up at a median of 73.8 months confirmed the difference: local progression-free rates were 94.1 percent at two years and 89.9 percent at five years after 24 Gy against 79.8 and 70.4 percent after 4 Gy. The corpus's follicular lymphoma page names involved-site radiotherapy of 24 Gy for localised disease on this evidence, while 4 Gy remains a useful palliative option.
- 89.9 vs 70.4 out of 100 alive without the cancer growing at 5 years with 24 Gy in 12 fractions compared with 4 Gy in 2 fractions; 19.5 more per 100.
- Roughly one extra person helped for every 5 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Put another way, the treated group had about 246 percent higher chance of the event at any given time (hazard ratio 3.46, likely range 2.25 to 5.33).
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- 94.1 vs 79.8 out of 100 alive without the cancer growing at 2 years with 24 Gy in 12 fractions compared with 4 Gy in 2 fractions; 14.3 more per 100.
- Roughly one extra person helped for every 7 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- The treated group had about 242 percent higher chance of the event at any given time (hazard ratio 3.42).
- The absolute difference, how many more people out of 100 were helped, is not reported here.
- 70 local progressions 21 local progressions; median follow-up 26 months
- This endpoint is not one of the standard survival or response measures; read it alongside the trial's primary result.
- These results apply to the people the trial enrolled: Follicular or marginal zone lymphoma needing local radiotherapy for cure or palliation, in 43 UK centres: 24 Gy in 12 fractions against 4 Gy in 2 fractions to the same site, with time to local progression in the irradiated field as the primary endpoint (non-inferiority). People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
548 randomised.
95% CI 85.5 to 93.1; 299 sites randomised · 95% CI 64.7 to 75.4; 315 sites randomised
Source95% CI 90.6 to 96.4 · 95% CI 74.8 to 83.9
Source70 local progressions · 21 local progressions; median follow-up 26 months
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Local progression-free rate at 5 years in the irradiated siteprimary | 24 Gy in 12 fractions | 299 | 89.9% | 3.46 (2.25 to 5.33) | - | link |
| 4 Gy in 2 fractions | 315 | 70.4% | ||||
| Local progression-free rate at 2 years in the irradiated site | 24 Gy in 12 fractions | 299 | 94.1% | - | - | link |
| 4 Gy in 2 fractions | 315 | 79.8% | ||||
| Time to local progression, first analysis (hazard for 4 Gy against 24 Gy) | 4 Gy in 2 fractions | - | 70 local progressions | 3.42 (2.09 to 5.55) | - | link |
| 24 Gy in 12 fractions | - | 21 local progressions; median follow-up 26 months |
Confirms 24 Gy in 12 fractions as the optimal dose for indolent lymphoma when durable local control is the goal.
24 Gy in 12 fractions is the standard radiotherapy dose for indolent lymphoma when durable local control is the aim; 4 Gy remains useful for palliation.
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