Abstract
PurposeThe role of consolidative radiotherapy (RT) after complete-remission (CR) following rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in advanced-stage diffuse large B-cell lymphoma (DLBCL) remains unclear. We retrospectively analyzed the survival outcomes and patterns of failure with our institutional experience.Material and MethodsBetween 2009 and 2018, 206 patients with stage III-IV DLBCL achieved CR after receiving R-CHOP. Propensity-score matching was used to analyze the role of consolidative RT. The consolidative RT group (n = 34) and the R-CHOP alone group (n = 68) were matched at a 1:2 ratio. After propensity-score matching, 102 patients were analyzed.ResultsWith a median follow-up of 39.7 months, 26 patients (25.5%) showed local recurrence. Only one patient failed at the previous RT field. RT was delivered to bulky sites, head and neck lesions, testes, and bone with median dose of 30.6 Gy. The most common site of failure was head and neck lesions followed by bulky sites. The 5-year overall survival (OS), progression-free survival (PFS), and isolated-local recurrence free survival (LRFS) were 73.5, 64.0, and 79.9%. In univariate and multivariate analysis, bone marrow involvement and consolidative RT were associated with isolated LRFS (p = 0.006 and 0.032) significantly.ConclusionConsolidative RT improved isolated local control. Based on the pattern of failure, we carefully suggest to radiate on initially involved bulky sites or head and neck lesions. Further studies need to be done to find out the optimal radiation dose and selection of RT site.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid neoplasm in adults [1] and the most common nonHodgkin’s lymphoma (NHL) subtype [2, 3]
Patients who were aged
172 patients received R-CHOP alone and 34 patients received R-CHOP followed by consolidative RT (Figure 1)
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid neoplasm in adults [1] and the most common nonHodgkin’s lymphoma (NHL) subtype [2, 3]. In the pre-rituximab era, the role of consolidative radiotherapy (RT) after chemotherapy has been studied in several randomized trials, including the Southwest Oncology Group (SWOG) 8736 trial, the Eastern Cooperative Oncology Group (ECOG) 1484 study, the Groupe d ‘Etudes des Lymphomes de I’Adulte (GELA LNH) 93-1 trial, and the GELA LNH 93-4 trial [6,7,8]. These landmark randomized trials aimed to show the potential benefits of RT, consolidative RT did not show significant improvement in survival outcomes. The role of consolidative RT remains unclear but the results of several studies, including the Italian lymphoma study group, Ricover-60 trial, and Min T trial [11, 12] support its beneficial role in early-stage DLBCL, with better local control (LC), progression-free survival (PFS), and OS
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