Radiotherapy as primary treatment for chronic lymphocytic leukaemia.

Conventional chemotherapy and local radiotherapy have failed to reverse the progressive haematological and immunological deterioration that characterizes the natural history of chronic lymphocytic leukaemia. At the National Cancer Institute, we have demonstrated that treatment with fractionated total-body irradiation has induced remissions sufficiently complete to modify the manifestations of disease which affect survival adversely. One-third of patients with active CLL have experienced responses distinguished by complete resolution of symptoms and palpable disease, correction of anaemia, restoration of the leucocyte count and differential to normal, clearing of the lymphocytic bone-marrow infiltration, and recovery from immunological incompetence. A distinct correlation has been observed between the response to therapy and the subsequent clinical course. The quality of life has been improved and the duration of survival prolonged in the group of patients who obtained the most favourable response (Type 1) to treatment. This establishes a rational for future attempts at reducing still further the tumour-cell burden. This view is in contrast to the generally accepted view that treatment has little if any influence upon the course of the disease or its prognosis.