How would you approach a young patient with stage I follicular lymphoma of the mesenteric lymph nodes?

This is an excellent question that is often discussed in guideline panel meetings- with a fair amount of disagreement among parties.

As radiation therapy leads to long-term disease control in ~50% of patients with stage I FL (and is not cured with either chemotherapy or immunotherapy), my preference is to treat most patients with localized FL with radiation therapy regardless of location.

With that in mind, the mesentery poses an interesting dilemma. Lymph nodes in the mesentery are scattered throughout a large area and move around significantly with the bowel. This affects two major decisions- is localized RT appropriate and how should we target the disease?

As for the first question, I generally recommend RT in patients with "localized" m...