Offer the same treatments that might be offered to people with advanced-stage (stages III and IV) symptomatic follicular lymphoma to people with stage IIA follicular lymphoma who are symptomatic and for whom radiotherapy is not suitable. Offer local radiotherapy as first-line treatment to people with localised stage IIA follicular lymphoma.Ĭonsider ‘watch and wait’ (observation without therapy) as first-line treatment for people with stage IIA follicular lymphoma who are asymptomatic and for whom treatment with a single radiotherapy volume is not suitable. Localised mediastinal or abdominopelvic presentations of follicular lymphoma are rare and so the more serious long term effects of radiotherapy such as cardiac deaths and second malignancies of the breast and lung are not major concerns. Most cases will involve irradiation to the neck, axilla or supraclavicular fossa. There are limited data on long term effects. Relatively low dose radiotherapy delivering 24Gy is effective in follicular lymphoma and if the disease is truly localised and encompassed in the radiation field then cure is possible. This topic focuses on the most effective first line treatment for stage IIA disease in the PET era. In stage IIA disease there is considerable controversy as to most appropriate therapy varying from watchful waiting to radiotherapy or immunochemotherapy. In stage IA follicular lymphoma a large proportion of patients can be cured by local radiotherapy and in some cases after complete excision observation only may be considered.

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