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Galunic Bilic L, Santek F, Mitrovic Z, Basic-Kinda S, Dujmovic D, Vodanovic M, Mandac Smoljanovic I, Ostojic Kolonic S, Galunic Cicak R, Aurer I. Long-Term Results of IFRT vs. ISRT in Infradiaphragmal Fields in Aggressive Non-Hodgkins's Lymphoma Patients-A Single Centre Experience. Cancers (Basel) 2024; 16:649. [PMID: 38339400 PMCID: PMC10854861 DOI: 10.3390/cancers16030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: This study aimed to examine the difference in efficacy and toxicity of involved-field (IFRT) and involved-site radiotherapy (ISRT) fields in infradiaphragmal aggressive non-Hodgkin lymphoma patients. (2) Methods: In total, 140 patients with infradiaphragmal lymphoma treated between 2003 and 2020 were retrospectively evaluated. There were 69 patients (49%) treated with IFRT, and 71 (51%) patients treated with ISRT. The median dose in the IFRT group was 36 Gy, (range 4-50.4 Gy), and in the ISRT group, it was 30 Gy (range 4-48 Gy). (3) Results: The median follow-up in the IFRT group was 133 months (95% CI 109-158), and in the ISRT group, it was 48 months (95% CI 39-57). In the IFRT group, locoregional control was 67%, and in the ISRT group, 73%. The 2- and 5-year overall survival (OS) in the IFRT and ISRT groups were 79% and 69% vs. 80% and 70%, respectively (p = 0.711). The 2- and 5-year event-free survival (EFS) in the IFRT and ISRT groups were 73% and 68% vs. 77% and 70%, respectively (p = 0.575). Acute side effects occurred in 43 (31%) patients, which is more frequent in the IFRT group, 34 (39%) patients, than in the ISRT group, 9 (13%) patients, p > 0.01. Late toxicities occurred more often in the IFRT group of patients, (10/53) 19%, than in the ISRT group of patients, (2/37) 5%, (p = 0.026). (4) Conclusions: By reducing the radiotherapy volume and the doses in the treatment of infradiaphragmatic fields, treatment with significantly fewer acute and long-term side effects is possible. At the same time, efficiency and local disease control are not compromised.
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Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, 10000 Zagreb, Croatia
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Ruzica Galunic Cicak
- Department of Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Igor Aurer
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
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2
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Galunic Bilic L, Santek F, Grah JJ, Basic-Kinda S, Mandac Smoljanovic I, Ostojic Kolonic S, Mitrovic Z, Vodanovic M, Dujmovic D, Aurer I. Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients: a single-centre experience. LA RADIOLOGIA MEDICA 2023; 128:492-500. [PMID: 36920724 DOI: 10.1007/s11547-023-01615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Data on efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients are scarce. We therefore performed this retrospective study to analyse our experience with radiotherapy exclusively to infradiaphragmal fields. MATERIALS AND METHODS we retrospectively evaluated 101 patients treated between 2003 and 2014. Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy. RESULTS After a median follow-up of 66 months (range 1-211 months), we observed lymphoma recurrence in 38 patients (38%), five in the RT field and 33 out-of-field. Recurrences were significantly more frequent in the salvage group (17 out-of-field and 4 in-field in 31 patients) than in adjuvant group (16 out-of-field and 1 in-field in 70 patients; p < 0.001). The 2-, 5- and 10-year event-free survival (EFS) rates were 62%, 56% and 54%. The 2-, 5- and 10-year overall survival (OS) rates for the entire group of patients are 73%, 60% and 54%, respectively. Acute side effects occurred in 43 (43%) patients, most frequent gastrointestinal in 26 (26%) patients. Late side effects occurred in 12 (12%) of all patients, 6 of 23 (26%) followed up for more than 10 years. Six patients developed secondary cancers, four gastrointestinal disturbances, two diabetes mellitus and three renal failure. CONCLUSION Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy. However, patients should be monitored for a secondary malignancy.
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Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Josip J Grah
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- Department for Radiotherapy, Univ. Klinik Für Strahlentherapie-Radioonkologie- LKH Graz, Graz, Austria
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Igor Aurer
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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3
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Berger MD, Trelle S, Büchi AE, Jegerlehner S, Ionescu C, de la Chapelle TL, Novak U. Impact on survival through consolidation radiotherapy for diffuse large B-cell lymphoma: a comprehensive meta-analysis. Haematologica 2021; 106:1923-1931. [PMID: 32554560 PMCID: PMC8252950 DOI: 10.3324/haematol.2020.249680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/12/2020] [Indexed: 01/09/2023] Open
Abstract
Rituximab has improved response rates and overall survival in B-cell lymphoma (DLBCL). Radiotherapy is an effective treatment modality for lymphomas, but there is uncertainty on its use as consolidation after chemo-immunotherapy mainly in advanced stages. We evaluated its efficacy with a comprehensive meta-analysis and a systematic search of Pubmed, Embase, Cochrane, and abstracts from ASCO, ASH, ESMO and ASTRO published from June 1966 and December 2018. We identified 11 trials that evaluated consolidation radiotherapy following chemotherapy in a randomized fashion in 4'584 patients. The primary endpoint of this meta-analysis was PFS. As three of the eleven trials were retracted, this data is based on 2414 patients. For the primary endpoint (PFS), we found a hazard ratio (HR) of 0.77 (0.51 to 1.17, pooled (tau2: 0.25; I2: 85%), and a HR of 0.80 (0.53 to 1.21, pooled (bivariate meta-analysis). For overall survival, the HR is 0.93 (0.61 to 1.40; pooled (tau2: 0.25; I2: 74%) and 0.86 (0.58 to 1.27) in a bivariate meta-analysis. The lack of benefit did not change over time (p-value: 0.95 (tau2: 0.32; I2: 88%), and was also absent for PFS when stratifying for chemotherapy, the use of Rituximab, age, the dose of radiotherapy, application to patients in complete remission and with bulky disease. None of the trials used a PET-guided approach. This meta-analysis revealed no survival benefit when consolidation radiotherapy is given to unselected DLBCL patients following chemotherapy. These results need to be considered in future trials in the PET-CT era.
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Affiliation(s)
- Martin D. Berger
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Annina E. Büchi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabrina Jegerlehner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Codruta Ionescu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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4
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Buteau JP, Seymour JF, Hofman MS. The evolving definition of bulky disease for lymphoma. Leuk Lymphoma 2020; 61:1525-1528. [PMID: 32684049 DOI: 10.1080/10428194.2020.1797014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- James P Buteau
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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5
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Aviles A, Calva A, Neri N, Cleto S, Silva L. Role of radiotherapy in diffuse large B‐cell lymphoma in advanced stages on complete response after administration of cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.1071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Agustin Aviles
- Oncology Research UnitHealth Investigation CoordinationNational Medical Center IMSS Mexico City Mexico
| | - Angel Calva
- Department of RadiotherapyNational Medical Center IMSS Mexico City Mexico
| | - Natividad Neri
- Department of HematologyOncology HospitalNational Medical Center IMSS Mexico City Mexico
| | - Sergio Cleto
- Department of HematologyOncology HospitalNational Medical Center IMSS Mexico City Mexico
| | - Luis Silva
- Department of HematologyOncology HospitalNational Medical Center IMSS Mexico City Mexico
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6
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Galunić Bilić L, Šantek F. INFRADIAPHRAGMAL RADIOTHERAPY IN PATIENTS WITH LYMPHOMA: VOLUME DEFINITION AND SIDE EFFECTS. Acta Clin Croat 2018; 57:554-560. [PMID: 31168189 PMCID: PMC6536292 DOI: 10.20471/acc.2018.57.03.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
SUMMARY – Lymphomas are very radiosensitive and radiotherapy (RT) was the first treatment modality that enabled cure. It is the most effective single modality for local control of lymphomas. However, as a local form of treatment, curative intention is only possible if all lymphoma tissue can be incorporated in the volume to be irradiated with the prescribed total irradiation dose. That is why RT is a single modality only in early stage of nodular lymphocyte predominance Hodgkin’s lymphoma and low grade non-Hodgkin’s lymphoma. In most patients, RT can be used as consolidation therapy after chemotherapy or as salvage after failure of chemotherapy. In the past two decades, irradiation techniques have been improved in order to spare critical tissues and reduce toxicity. Although effective, RT is a neglected modality of treatment because of the appearance of new drugs and fear of side effects after irradiation. Radiation has been shown to be effective in the treatment of all stages and forms of lymphoma. Study data are still mostly derived from patients that received supradiaphragmal RT; therefore, there is no agreement about the best management approach in patients with infradiaphragmal lymphoma.
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Affiliation(s)
| | - Fedor Šantek
- 1Department of Oncology and Radiotherapy, Zagreb University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia
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7
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Avilès A, Nambo MJ, Calva A, Neri N, Cleto S, Silva L. Retracted article: Adjuvant radiotherapy in patients with diffuse large B-cell lymphoma in advanced stage (III/IV) improves the outcome in the rituximab era. ACTA ACUST UNITED AC 2018; 24:521-525. [PMID: 29338665 DOI: 10.1080/10245332.2018.1423880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Statement of Retraction: Adjuvant radiotherapy in patients with diffuse large B-cell lymphoma in advanced stage (III/IV) improves the outcome in the rituximab era We, the Editor[s] and Publisher of Hematology, have retracted the following article: Avilès, A, Nambo, M-J, Calva, A, et al. Adjuvant radiotherapy in patients with diffuse large B-cell lymphoma in advanced stage (III/IV) improves the outcome in the rituximab era. Hematology. 2019;24:507-511; DOI: 10.1080/10245332.2018.1423880 The above article has been retracted as a result of concerns regarding the data upon which the presented research has been based. After re-examination and several independent expert reviews the consensus is that the data and results are not reliable and therefore the article must be retracted. The authors have agreed with this decision. We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as "Retracted".
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Affiliation(s)
- Agustin Avilès
- a Oncology Research Unit, Oncology Hospital National Medical Center, IMSS , Mexico D.F. , Mexico
| | - Maria-Jesus Nambo
- b Department of Hematology , Oncology Hospital National Medical Center, IMSS , Mexico D.F. , Mexico
| | - Angel Calva
- c Department of Radiotherapy , Oncology Hospital National Medical Center, IMSS , Mexico D.F. , Mexico
| | - Natividad Neri
- b Department of Hematology , Oncology Hospital National Medical Center, IMSS , Mexico D.F. , Mexico
| | - Sergio Cleto
- b Department of Hematology , Oncology Hospital National Medical Center, IMSS , Mexico D.F. , Mexico
| | - Luis Silva
- b Department of Hematology , Oncology Hospital National Medical Center, IMSS , Mexico D.F. , Mexico
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8
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Kobe C, Dietlein M, Hellwig D. PET/CT for Lymphoma Post-therapy Response Assessment in Hodgkin Lymphoma and Diffuse Large B-cell Lymphoma. Semin Nucl Med 2018; 48:28-36. [DOI: 10.1053/j.semnuclmed.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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9
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Yap E, Law ZK, Aslan Abdullah NM, Abdul Wahid SF. Consolidation radiotherapy for advanced-stage aggressive B-cell non-Hodgkin lymphoma: A systematic review and meta-analysis. EXCLI JOURNAL 2017; 16:1233-1248. [PMID: 29285019 PMCID: PMC5735338 DOI: 10.17179/excli2017-805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022]
Abstract
Patients with advanced aggressive B-cell non-Hodgkin lymphomas (NHL) are usually treated with rituximab in combination with chemotherapy. However, disease relapse rates are high. Radiotherapy (RT) has been shown to be efficacious in treating early-stage NHL but its role in advanced stage diseases is unclear. We performed a systematic review of randomized controlled trials (RCTs) comparing chemotherapy with RT to chemotherapy alone in patients with newly diagnosed advanced aggressive NHL. We searched online databases and pooled similar outcome estimates. For time-to-event outcomes, we estimated hazard ratios (HR) for overall survival (OS) and event-free survival (EFS) using the fixed-effect model. Two RCTs involving 254 patients met inclusion criteria. The trials were single-centre RCTs with follow-up period of five and ten years. Both trials were conducted in the pre-rituximab era. Patients treated with consolidation RT had better OS (HR for mortality 0.61; 95 % CI 0.38 to 0.97) and EFS (HR for mortality 0.67; 95 % CI 0.46 to 0.98) compared to those who received no RT. There was an apparent benefit of RT on local control (OR 0.09; 95 % CI 0.04 to 0.20); although this was estimated as a dichotomous rather than time-to-event outcome. Limited evidence shows benefits of consolidation RT in advanced aggressive NHL. However, we were not able to estimate the effect size with confidence due to small number of trials and sample size. We cannot recommend routine consolidation RT in advanced aggressive NHL. More RCTs with the inclusion of rituximab and PET-CT monitoring are needed.
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Affiliation(s)
- Ernie Yap
- Department of Medicine, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia
| | - Zhe Kang Law
- Department of Medicine, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia
| | - Nik Muhd Aslan Abdullah
- Department of Oncology, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia
| | - S Fadilah Abdul Wahid
- Department of Medicine, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia.,Cell Therapy Centre, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia
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10
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Patterns of failure of diffuse large B‑cell lymphoma patients after involved-site radiotherapy. Strahlenther Onkol 2017; 193:1014-1023. [DOI: 10.1007/s00066-017-1186-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
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11
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Avilés A, Talavera A, Díaz-Maqueo JC, Cleto S, Díaz NR, García EL. High Dose Chemotherapy in the Treatment of Poor Prognosis Malignant Lymphoma. Hematology 2016; 3:229-33. [DOI: 10.1080/10245332.1998.11746395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Agustin Avilés
- Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico
| | - Alejandra Talavera
- Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico
| | - José C. Díaz-Maqueo
- Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico
| | - Sergio Cleto
- Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico
| | - Noé R. Díaz
- Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico
| | - Edna L. García
- Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico
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12
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Avilés A, García EL, Victoria W, Neri N, Huerta-Guzmán J, Díaz-Maqueo JC. Randomized Clinical Trial to Evaluate Maintenance Therapy in Diffuse Large Cell Lymphoma Treated with Intensive Chemotherapy. Hematology 2016; 5:435-40. [DOI: 10.1080/10245332.2001.11746540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Edna L. García
- department of Hematology, Oncology Hospital, National Medical Center, IMSS
| | - Wilbert Victoria
- department of Hematology, Oncology Hospital, National Medical Center, IMSS
| | - Natividad Neri
- department of Hematology, Oncology Hospital, National Medical Center, IMSS
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13
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Avilés A, Díaz-Maqueo JC, Talavera A, García EL, Nambo MJ. Maintenance Therapy with Interferon Alfa 2b Improves Outcome in Aggressive Malignant Lymphoma. Hematology 2016; 3:381-6. [DOI: 10.1080/10245332.1998.11746412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Agustin Avilés
- Department of Hematology, Oncology Hospital, National Medical Center, México D.F. Mexico
| | - José C. Díaz-Maqueo
- Department of Hematology, Oncology Hospital, National Medical Center, México D.F. Mexico
| | - Alejandra Talavera
- Department of Hematology, Oncology Hospital, National Medical Center, México D.F. Mexico
| | - Edna L. García
- Department of Hematology, Oncology Hospital, National Medical Center, México D.F. Mexico
| | - M. Jesús Nambo
- Department of Hematology, Oncology Hospital, National Medical Center, México D.F. Mexico
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14
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Avilès A, Nambo MJ, Huerta-Guzmàn J, Silva L, Neri N. Rituximab as consolidation therapy did not improve outcome in patients with diffuse large B-cell lymphoma at complete response after dose-dense chemotherapy (CHOP-14). Cancer Biother Radiopharm 2016; 30:107-10. [PMID: 25871407 DOI: 10.1089/cbr.2014.1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The authors started a clinical trial to assess the efficacy and toxicity of rituximab (R) as consolidation in patients with diffuse large B-cell lymphoma, with poor prognostic factors, who were in complete response (CR) after dose-dense chemotherapy (CHOP-14). Four hundred sixty-five untreated patients, with advanced stages (III and IV), older (median age >60 years old), and high clinical risk, were treated with dose-dense CHOP-14 (cyclophosphamide 1500 mg/m(2), i.v., day 1; vincristine 2 mg, i.v., standard dose, day 1; epirubicin 120 mg/m(2), i.v., day 1; and prednisone 60 mg/m(2), p.o., days 1-5) every 14 days for six cycles. If CR was achieved, the patients were allocated to receive R (375 mg/m(2), days 1, 8, 15, and 22) at 3 and 9 months after chemotherapy. Three hundred twenty-five patients achieved CR (70%) and were allocated to receive R (151 patients) or not (174 patients). Actuarial curves at 5 years showed that progression-free survival (PFS) was 51% (95% confidence interval [CI]: 44%-58%) in the R group and 53% (95% CI: 47%-59%) in the observation group (p=0.8). Overall survival (OS) was 65% (95% CI: 58%-71%) and 66% (95% CI: 59%-72%), respectively (p=0.78). Late toxicities were more frequent in the R group. The authors showed that the use of R as a consolidation treatment was not useful to improve PFS and OS and toxicity secondary to R was frequent. They did not recommend the use of R as consolidation in this patient setting.
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Affiliation(s)
- Agustin Avilès
- 1 Oncology Research Unit, Oncology Hospital , National Medical Center, IMSS, Mèxico DF, Mexico
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15
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Mendes F, Domingues C, Teixo R, Abrantes AM, Gonçalves AC, Nobre-Gois I, Jacobetty M, Sarmento AB, Botelho MF, Rosa MS. The importance of radiotherapy on diffuse large B cell lymphoma treatment: a current review. Cancer Metastasis Rev 2015; 34:511-25. [PMID: 26267803 DOI: 10.1007/s10555-015-9581-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Diffuse large B cell lymphoma is recognized as a heterogeneous group of hematological malignancies; two main subtypes germinal center B and activated B cells are well defined although 15% of patients remain with unclassifiable disease. R-CHOP treatment has proven to provide very effective results in limited or advanced stage of the disease. However, treatment solely involving R-CHOP submits the patient to possible chemotherapy-induced toxicities, which may be avoided with the use of radiotherapy. Patients with early stage localized disease or who are particularly unresponsive to chemotherapy may be more suitable for mixed modality treatment with R-CHOP and consolidative radiotherapy. Although radiotherapy is being slowly phased out by other treatment strategies including chemotherapy and therapeutic drugs, it is still a highly important method of treatment. The different forms of radiotherapy can be used alongside these "new-age" treatment strategies to further improve prognostic outcomes and overall survival rates. The establishment of radiotherapy as a treatment strategy provides a highly beneficial prognostic advantage in early stage, localized disease.
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Affiliation(s)
- Fernando Mendes
- Biophysics Unit-IBILI.CNC, Faculty of Medicine of University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal. .,ESTESC-Coimbra Health School, Department Biomedical Laboratory Sciences, Polytechnic Institute of Coimbra, Coimbra, Portugal. .,Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine of University of Coimbra, Coimbra, Portugal.
| | - Cátia Domingues
- Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine of University of Coimbra, Coimbra, Portugal.,Applied Molecular Biology and Clinical University of Hematology, Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Ricardo Teixo
- Biophysics Unit-IBILI.CNC, Faculty of Medicine of University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal
| | - Ana Margarida Abrantes
- Biophysics Unit-IBILI.CNC, Faculty of Medicine of University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal.,Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Ana Cristina Gonçalves
- Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine of University of Coimbra, Coimbra, Portugal.,Applied Molecular Biology and Clinical University of Hematology, Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Inês Nobre-Gois
- Radiation Oncology Department, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Miguel Jacobetty
- Radiation Oncology Department, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Ana Bela Sarmento
- Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine of University of Coimbra, Coimbra, Portugal.,Applied Molecular Biology and Clinical University of Hematology, Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Maria Filomena Botelho
- Biophysics Unit-IBILI.CNC, Faculty of Medicine of University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal.,Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Manuel Santos Rosa
- Immunology Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Jegadeesh N, Rajpara R, Esiashvili N, Shi Z, Liu Y, Okwan-Duodu D, Flowers CR, Khan MK. Predictors of local recurrence after rituximab-based chemotherapy alone in stage III and IV diffuse large B-cell lymphoma: guiding decisions for consolidative radiation. Int J Radiat Oncol Biol Phys 2015; 92:107-12. [PMID: 25863758 DOI: 10.1016/j.ijrobp.2015.01.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (DLBCL) in the era of rituximab is not well defined. There is evidence that some patients with bulky disease may benefit, but patient selection criteria are not well established. We sought to identify a subset of patients who experienced a high local failure rate after receiving rituximab-based chemotherapy alone and hence may benefit from the addition of consolidative RT. METHODS AND MATERIALS Two hundred eleven patients with stage III and IV DLBCL treated between August 1999 and January 2012 were reviewed. Of these, 89 had a complete response to systemic therapy including rituximab and received no initial RT. Kaplan-Meier analysis and Cox proportional hazards regression were performed, with local recurrence (LR) as the primary outcome. RESULTS The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥ 5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥ 5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥ 15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV ≥ 15 (P=.10). CONCLUSIONS Advanced-stage DLBCL patients with stage III disease or with disease ≥ 5 cm appear to be at an increased risk for LR. Patients with <5-cm disease and SUVmax ≥ 15 may be at higher risk for LR. These patients may benefit from consolidative RT after chemoimmunotherapy.
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Affiliation(s)
- Naresh Jegadeesh
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Raj Rajpara
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Zheng Shi
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Yuan Liu
- Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, Georgia
| | - Derrick Okwan-Duodu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Christopher R Flowers
- Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Medical Oncology, Emory University, Atlanta, Georgia
| | - Mohammad K Khan
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
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Hu C, Deng C, Zou W, Zhang G, Wang J. The Role of Consolidative Radiotherapy after a Complete Response to Chemotherapy in the Treatment of Diffuse Large B-Cell Lymphoma in the Rituximab Era: Results from a Systematic Review with a Meta-Analysis. Acta Haematol 2015; 134:111-8. [PMID: 25925586 DOI: 10.1159/000370096] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP). The role of radiotherapy (RT) after complete response (CR) to RCHOP in patients with DLBCL remains unclear. This systematic review with a meta-analysis is an attempt to evaluate this role. METHODS Studies that evaluated RT versus no-RT after CR to RCHOP for DLBCL patients were searched in databases. Hazard ratios (HR) with their respective 95% confidence intervals (CI) were calculated using a random-effects model. RESULTS A total of 4 qualified retrospective studies (633 patients) were included in this review. The results suggested that RT improved overall survival (OS; HR 0.33, 95% CI 0.14-0.77) and progression-free/event-free survival (PFS/EFS; HR 0.24, 95% CI 0.11-0.50) in all patients compared with no-RT. In a subgroup analysis of patients with stage III-IV DLBCL, RT improved PFS/EFS (HR 0.19, 95% CI 0.07-0.51) and local control (HR 0.12, 95% CI 0.03-0.44), with a trend of improving OS (HR 0.35, 95% CI 0.12-1.05). CONCLUSION Consolidation RT could significantly improve outcomes of DLBCL patients who achieved a CR to RCHOP. However, the significance of these results was limited by these retrospective data. Further investigation of the role of consolidation RT in the rituximab era is needed.
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Affiliation(s)
- Chunhong Hu
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, PR China
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18
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Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity. Blood 2015; 125:22-32. [DOI: 10.1182/blood-2014-05-577189] [Citation(s) in RCA: 379] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Abstract
Although the majority of patients with diffuse large B-cell lymphoma (DLBCL) can be cured with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), patients who fail R-CHOP have a dismal outcome. Thus, optimization of front-line therapy, as well as the development of more effective salvage strategies, remains an important objective. Advances in molecular genetics have vastly improved our understanding of the biological diversity of DLBCL and have led to the discovery of key oncogenic pathways. In addition to the major molecular designations of germinal center B-cell and activated B-cell subtypes, next-generation sequencing technologies have unveiled the remarkable complexity of DLBCL and identified unique molecular targets that may be differentially exploited for therapeutic benefit. These findings have translated into a growing list of promising novel agents. Moving forward, it is of paramount importance to recognize the heterogeneity of DLBCL and to investigate these targeted agents within patient populations who are most likely to benefit. It will be necessary to prioritize drugs that affect key driver pathways and to combine them rationally to optimize their benefit. Improved prognostication and the availability of predictive biomarkers will be crucial to allow for the possibility of individualized risk-adapted therapy.
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Held G, Murawski N, Ziepert M, Fleckenstein J, Pöschel V, Zwick C, Bittenbring J, Hänel M, Wilhelm S, Schubert J, Schmitz N, Löffler M, Rübe C, Pfreundschuh M. Role of radiotherapy to bulky disease in elderly patients with aggressive B-cell lymphoma. J Clin Oncol 2014; 32:1112-8. [PMID: 24493716 DOI: 10.1200/jco.2013.51.4505] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) is standard care for aggressive B-cell lymphoma. A prospective trial was conducted to investigate the role of additive radiotherapy (RT) to bulky and extralymphatic disease. PATIENTS AND METHODS The best arm of the RICOVER-60 trial (6×R-CHOP-14+2R [R-CHOP administered once every 2 weeks plus two additional applications of rituximab] plus involved-field RT [36 Gy] to sites of initial bulky [≥ 7.5 cm] disease and extralymphatic involvement) was compared with a cohort receiving the same immunochemotherapy but without RT in an amendment to the RICOVER-60 trial (RICOVER-noRTh) in a prospective fashion. RESULTS After a median observation time of 39 months, 164 of 166 RICOVER-noRTh patients were evaluable. In a multivariable analysis of the intention-to-treat population adjusting for International Prognostic Index risk factors and age (> 70 years), event-free survival (EFS) of patients with bulky disease was inferior without additive RT (hazard ratio [HR], 2.1; 95% CI, 1.3 to 3.5; P = .005), with trends for inferior progression-free (PFS; HR, 1.8; 95% CI, 1.0 to 3.3; P = .058) and overall survival (OS; HR, 1.6; 95% CI, 0.9 to 3.1; P = .127). In a per-protocol analysis with 11 patients in RICOVER-noRTh excluded for receiving unplanned RT, multivariable analysis revealed HRs of 2.7 (95% CI, 1.3 to 5.9; P = .011) for EFS, 4.4 (95% CI, 1.8 to 10.6; P = .001) for PFS, and 4.3 (95% CI, 1.7 to 11.1; P = .002) for OS for patients not receiving RT to bulky disease. CONCLUSION Additive RT to bulky sites abrogates bulky disease as a risk factor and improves outcome of elderly patients with aggressive B-cell lymphoma. Whether RT can be spared in patients with (metabolic) complete remission after immunochemotherapy must be addressed in appropriately designed prospective trials.
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Affiliation(s)
- Gerhard Held
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Viola Pöschel, Carsten Zwick, Jörg Bittenbring, Jörg Schubert, Christian Rübe, and Michael Pfreundschuh, Universitätsklinikum des Saarlandes, Homburg; Marita Ziepert and Markus Löffler, Universität Leipzig, Leipzig; Mathias Hänel, Klinikum Chemnitz, Chemnitz; Sibylla Wilhelm, Städtisches Klinikum Karlsruhe, Karlsruhe; and Norbert Schmitz, Asklepios-Klinik St Georg, Hamburg, Germany
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Shi Z, Das S, Okwan-Duodu D, Esiashvili N, Flowers C, Chen Z, Wang X, Jiang K, Nastoupil LJ, Khan MK. Patterns of Failure in Advanced Stage Diffuse Large B-Cell Lymphoma Patients After Complete Response to R-CHOP Immunochemotherapy and the Emerging Role of Consolidative Radiation Therapy. Int J Radiat Oncol Biol Phys 2013; 86:569-77. [DOI: 10.1016/j.ijrobp.2013.02.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 11/16/2022]
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Polliack A, Van Besien K, Seymour J, Treadway A. Statement of retraction. Avilés A, Fernándezb R, Pérez F, Nambo MJ, Neri N, Talavera A, Castañeda C,González M, Cleto. Adjuvant radiotherapy in stage IV diffuse large cell lymphoma improves outcome. Leuk Lymphoma 2013; 54:1571. [PMID: 23777388 DOI: 10.3109/10428194.2013.808008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Shi Z, Esiashvili N, Flowers C, Das S, Khan MK. Renewed interest in the role of consolidative radiotherapy in advanced stage diffuse large B-cell lymphoma. Leuk Lymphoma 2013; 54:2122-30. [DOI: 10.3109/10428194.2013.779687] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Avilés A, Fernándezb R, Pérez F, Nambo MJ, Neri N, Talavera A, Castañeda C, González M, Cleto S. Retracted: Adjuvant Radiotherapy in Stage IV Diffuse Large Cell Lymphoma Improve Outcome. Leuk Lymphoma 2009; 45:1385-9. [PMID: 15359637 DOI: 10.1080/10428190410001667712] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The role of adjuvant radiotherapy to sites of nodal bulky disease in patients with aggressive diffuse large cell lymphoma (DLCL), and stage IV remain undefined. We began a prospective controlled clinical trial to evaluate impact in event free survival (EFS) and overall survival (OS) in a large cohort of patients with a longer follow-up. Between 1989 and 1995; 341 patients with aggressive DLCL and presence of nodal bulky disease (tumor mass > 10 cm) in pathological proven complete response after intensive chemotherapy were randomized to received either radiotherapy (involved fields, 40 Gy) or not. The 5-year EFS and OS in radiated patients were respectively: 82% (95% Confidence interval (CI): 70-89%) and 87% (95% 80-99%), that were statistically significant to control group: 55% (41-64%) (P < 0.001) and 66% (95% CI: 51-73%) (P < 0.01) respectively. Radiotherapy was well tolerated, acute toxicity was mild and until now late toxicity did not appear. The use of adjuvant radiotherapy improve EFS and OS and probably the possibility of cure in patients diffuse large cell lymphoma with worse prognostic factors. Thus, we felt that adjuvant radiotherapy will be considered as part of the initial treatment in this setting of patients.
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Affiliation(s)
- Agustin Avilés
- Oncology Hospital, National Medical Center, IMSS, México, DF, Mexico.
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24
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Yaeger TE, Lu JJ, Brady LW. Non-Hodgkin’s Lymphoma. Radiat Oncol 2008. [DOI: 10.1007/978-3-540-77385-6_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
There have been two major developments over the last decade that has led to improvements in outcome and longer survival for patients with diffuse large B-cell lymphoma (DLBCL). These developments have been firstly to increase the dose of active cytotoxic drugs and shorten the time between cycles, resulting in dose-dense and/or dose-intense regimens and secondly the addition of the anti-CD20 monoclonal antibody rituximab to chemotherapy. Both strategies have been associated with higher response rates, lower relapse rates, longer event-free survival (EFS) and improved overall survival (OS), particularly in better prognostic groups. A combination of dose-dense and dose-intense chemotherapy regimens plus rituximab is currently being tested to confirm that the use of both approaches confers survival advantage. High-risk, poorer-prognosis DLBCL remains a challenge, and new treatment strategies are required for these patients. Improvements in outcome may potentially be achieved through a greater understanding of the genetic abnormalities specifically associated with poorer-prognosis disease, and factors that lead to unresponsiveness to chemotherapy. The role of radiotherapy is currently less clearly defined than at anytime in the management of DLBCL and the current evidence for using radiotherapy in this disease is therefore rigorously reviewed.
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Affiliation(s)
- Tim Illidge
- School of Cancer Imaging Sciences, CR UK Paterson Institute for Cancer Research, University of Manchester, Manchester M20 4BX, UK.
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Avilés A, Cleto S, Huerta-Guzmán J, Neri N. Interferon alfa 2b as maintenance therapy
in poor risk diffuse large B-cell lymphoma in complete remission after intensive CHOP-BLEO regimens. Eur J Haematol 2008. [DOI: 10.1111/j.1600-0609.2001.00272.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pfreundschuh M, Ho AD, Cavallin-Stahl E, Wolf M, Pettengell R, Vasova I, Belch A, Walewski J, Zinzani PL, Mingrone W, Kvaloy S, Shpilberg O, Jaeger U, Hansen M, Corrado C, Scheliga A, Loeffler M, Kuhnt E. Prognostic significance of maximum tumour (bulk) diameter in young patients with good-prognosis diffuse large-B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: an exploratory analysis of the MabThera International Trial Group (MInT) study. Lancet Oncol 2008; 9:435-44. [DOI: 10.1016/s1470-2045(08)70078-0] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wendland MMM, Smith DC, Boucher KM, Asch JD, Pulsipher MA, Thomson JW, Shrieve DC, Gaffney DK. The impact of involved field radiation therapy in the treatment of relapsed or refractory non-Hodgkin lymphoma with high-dose chemotherapy followed by hematopoietic progenitor cell transplant. Am J Clin Oncol 2007; 30:156-62. [PMID: 17414465 DOI: 10.1097/01.coc.0000251242.32763.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with refractory/relapsed non-Hodgkin lymphoma (NHL) often receive high-dose chemotherapy (HDCT) followed by hematopoietic progenitor cell transplant (HPCT) as salvage therapy. We examined the role of involved field radiation therapy (IFRT) in this setting. METHODS The records of 167 patients with refractory/relapsed NHL who underwent HDCT followed by HPCT between February 1990 and November 2003 were reviewed. Fifty-three patients received IFRT and 114 did not receive IFRT in the peritransplant period. RESULTS Eighty patients were alive at the time of analysis with a median follow up for alive patients of 4.5 years in the no IFRT group and 4.2 years in the IFRT group (P = 0.53). Patients undergoing IFRT were more likely to have bulky (P = 0.02) and extranodal (P= 0.04) disease at initial diagnosis. There was no significant difference between the treatment groups regarding mortality in the first 100 days after HPCT (P = 0.31). Five-year overall survival rates were 46.7% for the no IFRT group and 40.0% for the IFRT group (P= 0.15). Disease-free survival was significantly worse for patients receiving IFRT (P = 0.02); however, when considering local control, the addition of IFRT resulted in a 5-year rate similar to that for patients who did not receive IFRT (68.6% vs. 72.0% respectively, P= 0.73). CONCLUSIONS Although disease-free survival was inferior in patients who received IFRT, despite more adverse clinical features the use of IFRT resulted in similar rates of local control and overall survival compared with those who did not receive IFRT. The use of IFRT was not associated with an increase in the risk of acute mortality or late events.
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Affiliation(s)
- Merideth M M Wendland
- Department of Radiation Oncology, Huntsman Cancer Hospital and the University of Utah, Salt Lake City, Utah 84112, USA
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Dickson BC, Serra S, Chetty R. Primary gastrointestinal tract lymphoma: diagnosis and management of common neoplasms. Expert Rev Anticancer Ther 2007; 6:1609-28. [PMID: 17134365 DOI: 10.1586/14737140.6.11.1609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Primary gastrointestinal lymphoma represents the most common location of extranodal lymphoma. With the bulk of disease manifesting within the gastrointestinal tract and contiguous lymph nodes, many of the lymphomas occurring in the peripheral lymph nodes can also present with primary gastrointestinal tract involvement. Molecular biology has recently enabled significant progress in the diagnosis and management of primary gastrointestinal lymphoma. Herein, we will discuss the major lymphomas affecting the bowel and highlight their key morphological, immunophenotypical and molecular diagnostic attributes. Similarly, in keeping with recent therapeutic advances, we will briefly discuss some important treatment considerations. Thus, this review is intended to offer clinicians and pathologists an overview of primary gastrointestinal lymphomas.
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Affiliation(s)
- Brendan C Dickson
- University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, Department of Pathology, 200 Elizabeth Street, 11th Floor, Residents and Fellows Room, Toronto, Ontario, Canada.
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31
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Dawson LA, Saito NG, Ratanatharathorn V, Uberti JP, Adams PT, Ayash LJ, Reynolds CM, Silver SM, Schipper MJ, Lichter AS, Eisbruch A. Phase I study of involved-field radiotherapy preceding autologous stem cell transplantation for patients with high-risk lymphoma or Hodgkin's disease. Int J Radiat Oncol Biol Phys 2004; 59:208-18. [PMID: 15093918 DOI: 10.1016/j.ijrobp.2003.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2003] [Accepted: 07/23/2003] [Indexed: 11/25/2022]
Abstract
PURPOSE This Phase I study was designed to evaluate the tolerability of involved-field radiotherapy (IFRT) to areas of persistent disease in patients with high-risk Hodgkin's disease and non-Hodgkin's lymphomas before autologous stem cell transplantation (ASCT). METHODS AND MATERIALS Thirty-one patients with primary refractory or relapsed Hodgkin's disease (n = 13) and non-Hodgkin's lymphoma (n = 18) were treated with IFRT followed by high-dose chemotherapy and ASCT. All patients had bulky disease (> or =5 cm) and/or an inadequate response to salvage chemotherapy. The IFRT dose was escalated to a maximum of 36 Gy. Dose-limiting toxicity was defined as Grade 3-4 Bearman toxicity (life-threatening/fatal toxicity occurring within 28 days of ASCT). The chemotherapy regimen consisted of cyclophosphamide, etoposide, and carmustine. RESULTS The delivered dose of IFRT was 20 Gy in 9 patients, 28-30 Gy in 20, and 32-36 Gy in 2 patients to mediastinal (n = 19) and nonmediastinal (n = 12) sites. The median interval between IFRT completion and ASCT was 19 days. One patient developed Bearman Grade 3 hepatic toxicity. No other Grade 3 or 4 Bearman toxicity was observed. An increased requirement for i.v. narcotics was observed in patients treated with mediastinal IFRT vs. nonmediastinal IFRT (p = 0.02). A trend toward increased mucositis severity was seen in patients previously treated with a larger number of chemotherapy agents (p = 0.09) and in those with a shorter interval between IFRT and ASCT (p = 0.12). Pulmonary toxicity was more common in patients treated with mediastinal IFRT than in those treated with nonmediastinal IFRT (21% vs. 0%, p = 0.13). The 2-year overall and progression-free survival rate was 70% and 49% for all patients, 84% and 50% for patients with Hodgkin's disease, and 59% and 47% for patients with non-Hodgkin's lymphoma, respectively. CONCLUSION The maximal tolerated dose of IFRT was not reached when Grade 3-4 Bearman toxicity was dose limiting. Increased pulmonary toxicity and mucositis severity was seen after mediastinal IFRT compared with nonmediastinal IFRT. Because local control was excellent, higher doses of IFRT are not recommended. The absolute benefit of IFRT in this patient population needs investigation in future studies.
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Affiliation(s)
- Laura A Dawson
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
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Avilés A, Neri N, Nambo MJ, Castañeda C, Talavera A, Huerta-Guzmán J, Murillo E. Maintenance Therapy with Interferon-α 2b, Cyclophosphamide, and Prednisone in Aggressive Diffuse Large Cell Lymphoma. Stem Cells Dev 2004; 13:205-9. [PMID: 15186737 DOI: 10.1089/154732804323046819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Maintenance therapy in patients with aggressive malignant lymphoma using biological modifiers remains uncertain. We conducted a controlled clinical trial to evaluate the efficacy and toxicity of interferon-alpha 2b, cyclophosphamide, and prednisone as maintenance therapy in patients with aggressive diffuse large B cell lymphomas in complete remission after aggressive chemotherapy. In an intent-to-treat analysis, 169 patients were eligible for this study; the end points were event-free survival (EFS) and overall survival (OS). With a median follow-up of 49.3 months, no statistical differences were observed and actuarial curves at 5 years showed that EFS was 71% (95% confidence interval [CI], 63-79%) for patients who received maintenance compared to 63% (95% CI, 59-71%) for patients in control group (p = 0.05). No statistical differences were observed in OS between maintenance arm: 84% (95% CI, 78-89%) and control group 83% (95% CI, 77-88%) in control group (p = 0.2). All patients received the maintenance therapy as planned and in time, thus dose intensity was considered 1.0 in all cases. Acute toxicity was mild, and no delay or suspension of treatment was necessary. Late toxicity was not evident until now. We conclude that use of maintenance therapy combining interferon-alpha 2b, cyclophosphamide, and prednisone is not useful in patients with aggressive lymphoma if they had been treated with aggressive combined chemotherapy.
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, Oncology Hospital, National Medical Center, IMSS, México, D.F. México.
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Pfreundschuh M. Therapeutic strategies for aggressive lymphomas. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Avilés A, Fernández R, Calva A, Neri N, Huerta-Guzmán J, Nambo MJ. Radiotherapy versus combined therapy in early stages with bulky disease aggressive malignant lymphoma. Hematology 2003; 8:7-10. [PMID: 12623421 DOI: 10.1080/1024533021000059456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The purpose of this study was to evaluate the use of radiotherapy compared with combined therapy (radiotherapy followed by chemotherapy) in early stages (I and II) in patients with diffuse large cell lymphoma and bulky disease. One hundred and thirty patients were randomly assigned to receive either radiotherapy involved field doses range from 40 to 48 Gy (median 44.5 Gy) or the same radiation therapy following chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone, by six cycles. Complete response (CR) was achieved in 58 out of 61 patients (95%) of the patients whose received radiotherapy, that was no different to 91% (63 out of 69 patients) in the combined therapy arm. However, at 10-years event-free survival (EFS) was 68% (95% confidence interval (CI): 61-73%) in the radiotherapy arm that was statistical different to 90% (95% CI: 86-94%) in the combined therapy group (p < 0.01). Overall survival (OS) showed statistical differences: 72% (95% CI 67-76%) in the radiotherapy group compared to 89% (95% CI: 84-93%) in the combined therapy arm (p < 0.01). Toxicity was mild in both groups, at this time, no second neoplasm or acute leukemia has been observed. We conclude that combined therapy appear to be superior in patients with early stages and bulky disease in patients with aggressive malignant lymphoma.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Epirubicin/administration & dosage
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Prednisone/administration & dosage
- Radiotherapy, High-Energy
- Remission Induction
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, Oncology Hospital, National Medical Center, IMSS, México, DF, Mexico.
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Avilés A, Delgado S, Fernández R, Talavera A, Neri N, Huerta-Guzmán J. Combined therapy in advanced stages (III and IV) of follicular lymphoma increases the possibility of cure: results of a large controlled clinical trial. Eur J Haematol 2002; 68:144-9. [PMID: 12068794 DOI: 10.1034/j.1600-0609.2002.01542.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We evaluate the long-term results of a randomized clinical trial in patients with advanced stages (III and IV) of follicular lymphoma using chemotherapy or combined therapy (chemotherapy following by adjuvant radiotherapy in patients with nodal bulky disease). MATERIAL AND METHODS Between 1981 and 1995, patients with follicular lymphoma were treated with combined chemotherapy, mostly anthracycline-based regimens; patients who achieved complete response were randomly assigned either to receive adjuvant radiotherapy to sites or to nodal bulky disease or not (control group). RESULTS Four hundred and sixty-nine patients were randomized; in an intent-to-treat analysis all were evaluable for efficacy and toxicity. Actuarial curves at 20yr showed that event-free survival (EFS) and overall survival (OS) in the control group were 41% [95% confidence interval (CI) 36-56%) and 71% (95% CI 65-78%), respectively; these were statistically different from results for the patients who received adjuvant radiotherapy: 68% (95% CI 62-72%) and 89% (95% CI 79-96%), respectively (P<0.01). Acute and late toxicity were minimal; only four patients (<1%) developed myelodysplastic syndrome/acute leukemia. Cardiac toxicity was 2%, but one case was lethal. Thirty-six patients (8%) died secondary to unrelated causes, in complete remission. CONCLUSIONS The use of adjuvant radiotherapy in patients with poor-prognosis follicular lymphoma increases EFS and OS with minimal toxicity. We feel that follicular lymphoma should be treated curatively because <80% of patients will be in first complete response at <20yr. The use of adjuvant radiotherapy will be considered in the first line of treatment in this set of patients.
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Affiliation(s)
- Agustin Avilés
- Research Unit in Oncological Diseases, Oncology Hospital, National Medical Center, IMSS, México D.F., Mexico.
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Wadhwa P, Shina DC, Schenkein D, Lazarus HM. Should involved-field radiation therapy be used as an adjunct to lymphoma autotransplantation? Bone Marrow Transplant 2002; 29:183-9. [PMID: 11859389 DOI: 10.1038/sj.bmt.1703367] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Relapse at sites of prior disease involvement accounts for the majority of treatment failures following high-dose therapy and autologous transplantation for both Hodgkin's disease and non-Hodgkin's lymphoma. Several studies have demonstrated the utility of 'involved-field' radiation as a treatment modality in this setting to minimize disease bulk prior to transplants, to reduce relapse rates at sites of prior disease involvement and to improve local control for disease resistant to high-dose therapy. Other studies recommend caution due to potential toxicities including radiation-induced pneumonitis and secondary myelodysplasia. Further investigations are needed to better define the optimal extent, dose and timing of radiation in the setting of transplantation, as well as to identify those subsets of patients likely to be at a higher risk of radiation-induced morbidity.
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Affiliation(s)
- P Wadhwa
- Department of Medicine, Comprehensive Cancer Center of the University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH 44106, USA
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Cox JD, Ha CS, Wilder RB. Radiation therapy for malignant lymphoma: enduring importance in the era of systemic therapy. Biomed Pharmacother 2001; 55:516-8. [PMID: 11769958 DOI: 10.1016/s0753-3322(01)00131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- J D Cox
- Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Avilés A, Díaz-Maqueo JC, García EL, Talavera A, Huerta-Guzmán J, Neri N. Late lethal events in patients with diffuse large B cell lymphoma: a review of 714 patients treated in a single centre. Leuk Lymphoma 2001; 42:631-7. [PMID: 11697491 DOI: 10.3109/10428190109099323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Presence of late lethal events has been recognized as a complication in patients with malignant lymphoma. We reviewed 714 cases of patients treated during 1975-1995 with a long term follow-up (>4 years) in an attempt to identify all late events secondary to malignant lymphoma, either to the treatment or those which are unrelated. Forty-three patients died, and of these 21 (2.8%) were secondary to relapse and tumor progression; deaths associated with second neoplasm and cardiac events were increased 9.6 fold and 26.4 fold respectively compared to the general population. The risk factors for these complications did not differ from those in previous reports and included alkylating agents and/or radiotherapy for second neoplasms and anthracycline therapy and radiotherapy for cardiac toxicity. Moreover, 10 patients died secondary to non-related events. Nevertheless, at 10 years overall survival was 94% (95% confidence interval (CI): 82% to 98%) and event free survival was 97.1% (95% CI: 81% to 98%), for these patients. Thus, second events, fatal in most cases, will be considered as an expected risk in the treatment of patients with malignant lymphoma. The proposed modifications of therapy many indeed be useful to avoid or diminish these complications in the future.
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MESH Headings
- Adult
- Aged
- Alkylating Agents/therapeutic use
- Alkylating Agents/toxicity
- Anthracyclines/therapeutic use
- Anthracyclines/toxicity
- Cardiovascular Diseases/etiology
- Cause of Death
- Data Collection
- Female
- Humans
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/mortality
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Middle Aged
- Neoplasms, Second Primary/etiology
- Radiotherapy, Adjuvant/adverse effects
- Recurrence
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Affiliation(s)
- A Avilés
- Department of Hematology, Hospital National Medical Center IMSS, México, DF, Mexico.
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Wilder RB, Rodriguez MA, Tucker SL, Ha CS, Hess MA, Cabanillas FF, Cox JD. Radiation therapy after a partial response to CHOP chemotherapy for aggressive lymphomas. Int J Radiat Oncol Biol Phys 2001; 50:743-9. [PMID: 11395243 DOI: 10.1016/s0360-3016(01)01503-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the results with involved-field radiotherapy after aggressive lymphomas had decreased in size by 50-99% in response to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy. METHODS AND MATERIALS From 1988 through 1996, 294 previously untreated patients with Working Formulation intermediate-grade or large-cell immunoblastic lymphomas underwent CHOP-based chemotherapy on 2 consecutive protocols at the M. D. Anderson Cancer Center. Forty-four (15%) of these patients achieved, based on international working group guidelines, a partial (50-75%) response (n = 25), or unconfirmed complete (76-99%) response (n = 19) to a median of 6 cycles of chemotherapy. These patients were treated with salvage involved-field radiotherapy (n = 32) or chemotherapy (n = 12), e.g., MINE-ESHAP, without autologous stem-cell rescue (ASCR). RESULTS Median follow-up was 43 months. Partial responders experienced similar outcomes to unconfirmed complete responders. Local control (4-year rates: 86% vs. 53%, p = 0.009) and progression-free survival (4-year rates: 67% vs. 8%, p < 0.0001), but not overall survival (4-year rates: 70% vs. 50%, p = 0.067) were significantly better in those who received salvage radiotherapy, which was well tolerated. CONCLUSION Progression-free and overall survival in aggressive lymphoma patients who underwent salvage radiotherapy were similar to results reported for high-dose chemotherapy with ASCR. The role of salvage radiotherapy in partial and unconfirmed complete responders to CHOP chemotherapy justifies examination in a large, cooperative group trial.
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Affiliation(s)
- R B Wilder
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Avilés A, Cleto S, Huerta-Guzmán J, Neri N. Interferon alfa 2b as maintenance therapy in poor risk diffuse large B-cell lymphoma in complete remission after intensive CHOP-BLEO regimens. Eur J Haematol 2001; 66:94-9. [PMID: 11168516 DOI: 10.1034/j.1600-0609.2001.00272.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We conducted a randomized clinical trial to evaluate the role of interferon alfa 2b (IFN) as maintenance therapy in patients with diffuse large B-cell lymphoma with high or high-intermediate clinical risk on complete remission (CR) after CHOP-BLEO regimens. METHODS Patients were initially treated with CHOP-BLEO regimens (which include increased doses of cyclophosphamide and epirubicine, instead of doxorubicin). If the patients achieved CR they were randomly assigned to receive either maintenance therapy with IFN 5.0 MU, three times at week by 1 yr, or no treatment (control group). RESULTS Two hundred and twenty-three patients were considered as candidates for the study. They were of high (80%) or high-intermediate (20%) clinical risk; additionaly most patients had poor prognostic factors such as high levels of beta 2 microglobulin, lactic dehydrogenase levels, bulky disease (defined as a tumor mass >10 cm) or multiple extranodal involvement. In an intent-to-treat analysis all patients were evaluable to efficacy and toxicity. Median follow-up was 45 months, the estimated 5-yr overall survival and event-free survival (EFS) for patients who received IFN were 71% (95% confidence interval (CI): 61-83%) and 57% (95% CI: 39-69%), respectively, values which were not statistically different from the control group: 69% (95% CI: 63-79%) and 54% (95% CI: 37-63%), respectively (p=0.2). Toxicity was mild. CONCLUSIONS These results suggest that IFN used as maintenance therapy at these doses and schedules is not useful in aggressive malignant lymphoma when more intensive chemotherapy has been employed during induction treatment. Nevertheless, follow-up is too short, and long-term follow-up would be necessary in order to draw definitive conclusions. Probably, an multicenter study is necessary to define the role of IFN as maintenance therapy in this patient setting.
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Affiliation(s)
- A Avilés
- Department of Hematology, Oncology Hospital, National Medical Center, IMSS, México, DF, Mexico.
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Wilder RB, Rodriguez MA, Ha CS, Pro B, Hess MA, Cabanillas F, Cox JD. Bulky disease is an adverse prognostic factor in patients treated with chemotherapy comprised of cyclophosphamide, doxorubicin, vincristine, and prednisone with or without radiotherapy for aggressive lymphoma. Cancer 2001. [DOI: 10.1002/1097-0142(20010615)91:12<2440::aid-cncr1279>3.0.co;2-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Avilés A, Neri N, Fernández R, Huerta-Guzmán J, Talavera A. Results of a Controlled Clinical Trial Radiotherapy versus Combined Therapy in the Management of Stage IE Orbital Marginal Zone B-cell Lymphoma. Hematology 2001; 6:181-5. [PMID: 27420124 DOI: 10.1080/10245332.2001.11746570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The aim of the present study was to compare the usefulness of radiotherapy (34-40 Gy, median 3.8 Gy) versus radiotherapy following by adjuvant chemotherapy in the management of 73 patients with stage I marginal zone B cell lymphoma (MZBCL) of the orbit. Complete response was similar in both arms: 95% (95% confidence interval (CI): 89-99%) in the radiotherapy group and 100% (95% CI: 92-104%) in the combined therapy arm. At a median follow-up of 8 years no median has been reached in event free survival (EFS) and overall survival (OS). At 8-years EFS shown that 87% (95%CI: 82-93%) and 82%, (95%CI: 78-87%), respectively remain in first complete response (p=0.6). OS was very similar 87% (95% CI: 84-89%) and 90%, (95% CI: 84-95%), respectively (p=0.5). Because we use low-radiation therapy (<50Gy) acute and late toxicities were mild. We concluded that combined therapy it is not useful in the treatment of MZBCL primary of the orbit and confirm that radiotherapy is the treatment of choice in this setting of patients.
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Affiliation(s)
- A Avilés
- a Research Unit in Oncologic Diseases, Oncology Hospital , National Medical Center , IMSS, México , DF , Mexico
| | - N Neri
- b Hematology Department , Oncology Hospital , National Medical Center , IMSS , México , DF , Mexico
| | - R Fernández
- c Radiotherapy Department , Oncology Hospital , National Medical Center , IMSS , México , DF , Mexico
| | - J Huerta-Guzmán
- b Hematology Department , Oncology Hospital , National Medical Center , IMSS , México , DF , Mexico
| | - A Talavera
- b Hematology Department , Oncology Hospital , National Medical Center , IMSS , México , DF , Mexico
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Schlembach PJ, Wilder RB, Tucker SL, Ha CS, Rodriguez MA, Hess MA, Cabanillas FF, Cox JD. Impact of involved field radiotherapy after CHOP-based chemotherapy on stage III-IV, intermediate grade and large-cell immunoblastic lymphomas. Int J Radiat Oncol Biol Phys 2000; 48:1107-10. [PMID: 11072169 DOI: 10.1016/s0360-3016(00)00760-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the impact of involved field radiotherapy on local control, freedom from progression, and overall survival in patients with clinical Stage III-IV, intermediate grade, or large-cell immunoblastic lymphomas that responded to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based induction chemotherapy. METHODS AND MATERIALS From July 1989 through October 1996, 32 patients with clinical Stage III and 27 patients with clinical Stage IV, intermediate grade, or large-cell immunoblastic lymphomas were prospectively enrolled on two protocols at The University of Texas M. D. Anderson Cancer Center. None had previously undergone treatment for lymphoma. The median patient age was 54 years (range: 26-85 years). There were a total of 172 involved sites of disease at presentation. All 59 patients received CHOP-based chemotherapy. At least six cycles of chemotherapy were delivered to 92% of the patients. Involved field radiotherapy (39.6-40.0 Gy in 20-22 fractions in 74% of cases) was administered to 28/59 (47%) patients beginning 3-4 weeks after chemotherapy. Sites were irradiated at the discretion of the treating physician. Irradiated and nonirradiated groups were compared in terms of maximum pre-chemotherapy tumor size and University of Texas M. D. Anderson Cancer Center tumor score. Kaplan-Meier estimates of local control per patient, freedom from progression, and overall survival for the irradiated and nonirradiated groups were calculated in terms of the stage of disease and treatment delivered. The resulting curves were compared using the log-rank test. The Cox proportional hazards model was used to assess the prognostic significance of tumor size, tumor score, treatment delivered, and stage. RESULTS The median length of follow-up for all patients was 53 months (range: 4-96 months). The median tumor size at the start of chemotherapy in irradiated patients was 4.5 cm (range: 0-15 cm) versus 3 cm (range: 0-7 cm) in nonirradiated patients (p = 0.004). The irradiated and nonirradiated groups were not significantly different in terms of tumor scores. Radiotherapy improved (p = 0.001) local control (5-year rates: 89% versus 52%) for Stages III and IV combined. This benefit was due to the dramatic improvement (p = 0.0009) in local control for patients with lymphomas measuring > or =4 cm at the start of chemotherapy (5-year rates: 89% for irradiated patients versus 33% for nonirradiated patients). Radiotherapy also improved (p = 0.003) freedom from progression (5-year rates: 85% for irradiated patients versus 51% for nonirradiated patients) for Stages III and IV combined. On multivariate analysis, radiotherapy was the most significant factor affecting local control and freedom from progression. Overall survival was not significantly different (p = 0. 620) between irradiated and nonirradiated patients (5-year rates: 87% versus 81%, respectively). When Stages III and IV were analyzed separately, radiotherapy improved local control and freedom from progression but not overall survival. Radiotherapy was tolerated reasonably well, with the main toxicity being moderate myelosuppression. Eleven out of 12 (92%) patients with recurrent disease at the time of their last follow-up visit were treated initially with chemotherapy alone. CONCLUSION Involved field radiotherapy improved local control and freedom from progression in patients with > or = 4 cm Stage III-IV, intermediate grade, or large-cell immunoblastic lymphomas that responded to CHOP-based induction chemotherapy. Involved field radiotherapy was tolerated reasonably well.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Disease Progression
- Doxorubicin/administration & dosage
- Follow-Up Studies
- Humans
- Lymphoma, Large-Cell, Immunoblastic/drug therapy
- Lymphoma, Large-Cell, Immunoblastic/pathology
- Lymphoma, Large-Cell, Immunoblastic/radiotherapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/radiotherapy
- Middle Aged
- Neoplasm Staging
- Prednisone/administration & dosage
- Prognosis
- Proportional Hazards Models
- Prospective Studies
- Vincristine/administration & dosage
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Affiliation(s)
- P J Schlembach
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA
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Maisey NR, Hill ME, Webb A, Cunningham D, Flux GD, Padhani A, Ott RJ, Norman A, Bishop L. Are 18fluorodeoxyglucose positron emission tomography and magnetic resonance imaging useful in the prediction of relapse in lymphoma residual masses? Eur J Cancer 2000; 36:200-6. [PMID: 10741278 DOI: 10.1016/s0959-8049(99)00249-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Treatment of both Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) frequently results in a residual mass visible radiologically. Such patients may receive radiotherapy unnecessarily because the residual mass may represent benign fibrotic tissue rather than residual active lymphoma. Radiotherapy has been shown to have significant short and more worrying long-term toxicity. Refining the criteria for its use would be a major advance. A number of clinical investigations have been evaluated to more accurately determine the nature of such lesions, including erythrocyte sedimentation rate (ESR), magnetic resonance imaging (MRI) and high-dose gallium-67 scanning (HDGS) but none has proven utility. 18[F]-fluorodeoxyglucose positron emission tomography (FDG-PET) is an imaging technique that has been shown to be useful in distinguishing fibrosis from residual active disease in solid tumours. The aim of this study was to compare FDG PET and MRI in the assessment of residual masses following treatment for lymphoma. Patients with NHL/HD who had a residual mass following chemotherapy were eligible for this study. Patients had a combination of MRI and/or PET. All scans were completed within 5 months of the end of treatment. Patients were followed-up for relapse. 56 patients had an MRI scan, 24 had a PET scan and 22 patients had both investigations. Overall sensitivity and specificity, respectively, were for MRI 45% and 74%, PET 50% and 69%, and PET/MRI concurring 50% and 67%. There was a trend for improved relapse-free survival (RFS) with a negative result of both MRI and PET, but this was not statistically significant. The predictive value for both tests failed to reach statistical significance. Subgroup analysis suggests that PET may be better at predicting relapse in patients with NHL, especially those with masses above the diaphragm. There is no convincing evidence that either MRI or PET or the combination can reliably predict relapse within residual masses after treatment for lymphoma. A negative PET scan however appears to be more informative than a positive result and may well aid clinical decision making. There are a number of factors that may produce false-positive results, including post-treatment inflammatory changes, the sensitivity of the test in the setting of minimal residual disease and the heterogeneity of the histological subtypes studied. A negative PET (or MRI) result in lymphoma residual masses following therapy may negate the necessity for further therapy such as chemotherapy or radiotherapy and their concomitant toxicities.
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Affiliation(s)
- N R Maisey
- Department of Medicine, Royal Marsden NHS Trust, Sutton, Surrey, UK
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Abstract
In most cases, lymphoma is a systemic disease even when detected at an early stage. Although radiation is primarily a local treatment, the exquisite radiosensitivity of lymphomas to radiation has allowed radiotherapy to remain an important component in the management of both indolent and aggressive types of lymphoma. Recent studies established the following points: 1) For early-stage intermediate grade lymphoma, combined modality is the treatment of choice. 2) A large fraction of patients with stage I-II low-grade lymphoma attain long-term disease-free survival with radiation alone. 3) Extranodal mucosa associated lymphoid tissue lymphomas are easily controlled with low-dose involved-field radiotherapy. Preliminary data suggest that even in an advanced-stage, intermediate-grade, adjuvant radiotherapy to bulky sites may improve outcome. This issue merits further study.
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Affiliation(s)
- J Yahalom
- Memorial Sloan-Kettering Cancer Center, and Radiation Oncology in Medicine, Cornell University Medical College, New York, NY, USA.
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Avilés A, Talavera A, Díaz NR, Neri N. Interferon as maintenance therapy in refractory malignant lymphoma. JOURNAL OF HEMATOTHERAPY 1999; 8:263-7. [PMID: 10417049 DOI: 10.1089/106161299320280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Patients with refractory malignant lymphoma (RML) have a poor prognosis when treated with conventional chemotherapy, as less than 20% remain alive and free of disease after 5 years. The use of myeloablative chemotherapy followed by BMT has improved the complete remission (CR) rate. Nevertheless, relapse rates remain unchanged, and only a few patients remain alive and free of disease for more than 3 years. For this reason, we began a prospective randomized clinical trial to determine if IFN-alpha2B (5.0 MU three times a week for 1 year) can improve the prognosis in RML. Ninety-six patients with high or high-intermediate clinical risk RML and in CR after intensive chemotherapy were randomly assigned to receive or not to receive IFN as maintenance therapy. A median follow-up of 48.1 months, the time to treatment failure and survival were similar in both groups. Toxicity secondary to IFN administration was mild, and all patients received the planned doses of IFN. We conclude that IFN is not recommended at this dose and schedule as maintenance therapy in patients with RML who achieve CR. Different therapeutic approaches may be developed to improve outcomes for these patients.
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Affiliation(s)
- A Avilés
- Department of Hematology, Oncology Hospital, National Medical Center, México, DF Mexico
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Carter DL, Marks LB, Bean JM, Broadwater G, Hussein A, Vredenburgh JJ, Peters WP, Prosnitz LR. Impact of consolidation radiotherapy in patients with advanced breast cancer treated with high-dose chemotherapy and autologous bone marrow rescue. J Clin Oncol 1999; 17:887-93. [PMID: 10071280 DOI: 10.1200/jco.1999.17.3.887] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the impact of consolidation radiotherapy (RT) after high-dose chemotherapy with autologous bone marrow rescue (HDC) in patients with advanced breast cancer. PATIENTS AND METHODS Between 1988 and 1994,425 patients with metastatic or recurrent breast cancer received doxorubicin, fluorouracil, and methotrexate (AFM) induction chemotherapy in a single-institution prospective trial. One hundred patients who achieved a complete response were randomized to receive HDC (cyclophosphamide, cisplatin, carmustine), with autologous bone marrow rescue immediately after AFM, or to observation, with HDC to be administered at next relapse. Seventy-four of the 100 became eligible for RT; 53 received consolidation RT (HDC RT+ and 21 did not (HDC RT-). The assignment of RT was not randomized. The RT+ and RT- groups were similar with regard to number of involved sites, the fraction of patients with only local-regional disease, age, and interval since initial diagnosis. Local control at previously involved sites and distant sites was assessed with extensive radiologic and clinical evaluations at the time of first failure or most recent follow-up. The impact of RT on failure patterns, event-free survival, and overall survival was evaluated. RESULTS Sites of first failure were located exclusively at previously involved sites in 28% of RT+ patients versus 62% of RT- patients (P < .01). Event-free survival at 4 years was 31% and 21% in the RT+ and RT-groups, respectively (P = .02). Overall survival at 4 years was 30% and 16% in the RT+ and RT- groups, respectively (P = .20). CONCLUSION Patients with advanced breast cancer who were treated with HDC without RT failed predominantly at the initial sites of disease. The addition of RT appeared to reduce the failure rate at initial disease sites and may improve event-free and overall survival. Our observations await verification in a trial in which assignment to RT is randomized.
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Affiliation(s)
- D L Carter
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
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Yamaue H, Tanimura H, Terasawa H, Nakatani Y, Tsunoda T, Tani M, Iwahashi M. Intraoperative radiation therapy for a patient with bulky disease of mesenteric non-Hodgkin's lymphoma. Surg Today 1998; 28:467-70. [PMID: 9590723 DOI: 10.1007/s005950050167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A long survival is rarely observed in patients demonstrating recurrent malignant lymphoma with bulky disease because of the appearance of chemoresistant tumor cells after extensive chemotherapy, and moreover the presence of bulky disease has also been consistently associated with a poorer response rate and a shortened survival, due to the fact that tumor size is the most significant factor for the treatment of non-Hodgkin's lymphoma. We herein describe a case of a 53-year-old woman presenting with the chief complaint of abdominal fullness, who underwent intraoperative radiation therapy (IORT) for recurrent bulky non-Hodgkin's lymphoma in the mesenterium. The patient has had no evidence of tumor recurrence, based on the findings of regular abdominal computed tomographic scans, 60 months after initial chemotherapy and 28 months after IORT.
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Affiliation(s)
- H Yamaue
- Second Department of Surgery, Wakayama Medical School, Japan
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49
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Perry AR, Goldstone AH. High-dose therapy for diffuse large-cell lymphoma in first remission. Ann Oncol 1998; 9 Suppl 1:S9-14. [PMID: 9581236 DOI: 10.1093/annonc/9.suppl_1.s9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Diffuse large-cell lymphoma (DLCL) is curable by first-line conventional chemotherapy in 50%-60% of patients. High-dose therapy makes no contribution to this group of patients and, if applied indiscriminately as first-line consolidation therapy, is likely to unnecessarily increase overall morbidity and mortality. Instead, recent interest has been directed towards (a) the identification of a group of patients with a poor prognosis, and (b) the intensification of first-line treatment for such patients with high-dose therapy and allied regimens. Many prognostic factors have now been standardised, while studies are progressing in the identification of newer prognostic factors, such as the molecular markers. Multi-centre randomised trials are currently in progress to determine the appropriate level of treatment for prognostic subsets, with the value of high-dose therapy being assessed for those in the worst prognostic groups.
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Affiliation(s)
- A R Perry
- University College London Hospitals, UK
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50
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Stuschke M, Nowrousian MR. [Value of radiotherapy in disseminated highly malignant non-Hodgkin's lymphoma. Comment on the article by U. Kaiser, R. Pfab, K. Havemann, Strahlenther Onkol 1997, 173, 136-40 (No. 3)]. Strahlenther Onkol 1998; 174:220. [PMID: 9581184 DOI: 10.1007/bf03038531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Follow-Up Studies
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/radiotherapy
- Middle Aged
- Prednisone/therapeutic use
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Terminology as Topic
- Time Factors
- Vincristine/therapeutic use
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