# FoRT long-term follow-up: 4 Gy versus 24 Gy for follicular and marginal zone lymphoma

Source: https://onco.cc/key-papers/paper-fort-long-term-follow-up-hoskin-lancet-oncol-2021/  
OnCo record `paper-fort-long-term-follow-up-hoskin-lancet-oncol-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Five years on, the higher radiotherapy dose still controlled indolent lymphoma far better: 90 percent of treated sites were free of regrowth after 24 Gy against 70 percent after 4 Gy.

## Summary

Long-term follow-up of the FoRT trial (614 target sites in 548 patients) at a median of 73.8 months: 117 local progression events, 27 after 24 Gy and 90 after 4 Gy.

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 (hazard ratio 3.46).

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet Oncology
- Year: 2021
- DOI: 10.1016/S1470-2045(20)30686-0
- Authors: Hoskin P, Popova B, Schofield O, et al.
- Findings: Five-year local progression-free rate 89.9 percent (95% CI 85.5 to 93.1) after 24 Gy versus 70.4 percent (64.7 to 75.4) after 4 Gy.; Hazard ratio 3.46 (95% CI 2.25 to 5.33) at a median follow-up of 73.8 months.
- What it means: Confirms 24 Gy in 12 fractions as the optimal dose for indolent lymphoma when durable local control is the goal.
- Caveats: Overall survival was not the endpoint and most patients had further systemic options at progression.

## Sources

- Lancet Oncol 2021: https://doi.org/10.1016/S1470-2045(20)30686-0
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33539729/

## Connected records

- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- trials: [FoRT](https://onco.cc/trials/fort/), [FORTplus](https://onco.cc/trials/fortplus/)
- key papers: [Randomized trial of systemic therapy after involved-field radiotherapy in patients with early-stage follicular lymphoma: TROG 99.03](https://onco.cc/key-papers/paper-trog-99-03-radiotherapy-systemic-therapy-early-follicular-jco-2018/)
- cancers: [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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