Consolidation Radiotherapy Following Brief Chemotherapy for Localized Diffuse Large B-cell Lymphoma: A Prospective Study

R-CHOP with dose-attenuated radiation therapy could induce good prognosis in gastric diffuse large B cell lymphoma

Background

The treatment strategy for gastric diffuse large cell lymphoma (DLBCL) has not been standardized in such as to the cycles of chemotherapy, dose of radiation, or necessity for the surgery. Although the results of CHOP or R-CHOP treatments have demonstrated the good prognosis, the treatments have been controversial in many cases.

Methods

We retrospectively analyzed 40 gastric DLBCL patients receiving chemotherapy with or without radiation in our institute. Those in stages II-IV were treated with six cycles of R-CHOP without radiation; for those in stage I, we administered three cycles of R-CHOP with radiation.

Results

The three-year overall survival (OS) and progression-free survival (PFS) rates were 95.2 and 91.8%, respectively. Those in stage I obtained 100% of OS. The radiation dose prescribed was 30.6 Gy for CR cases and 39.6 to 40 Gy for PR after chemotherapy. Although survival rates tended to correlate with staging groups or age-adjusted IPI classifications, multivariate statistical analysis did not show clear differences. All 14 patients with initial bleeding were successfully managed without surgery during treatment.

Conclusion

R-CHOP therapy was very effective for gastric DLBCL. It may be not necessary to use more than 30.6 Gy of radiotherapy in the highly chemo-sensitive cases. Less toxic treatments should be made available to gastric DLBCL patients.

A long-term follow-up study of prospective 80%-dose CHOP followed by involved-field radiotherapy in elderly lymphoma patients

OBJECTIVE

The purpose of this study was to clarify the long-term clinical outcome of elderly patients with localized aggressive lymphoma and to explore appropriate treatment strategies for this population.

METHODS

Subjects of this multicenter prospective study were untreated patients aged ≥70 years with aggressive Stage IA-IIA lymphoma. Therapy with 80%-dose CHOP (cyclophosphamide 600 mg/m(2), doxorubicin 40 mg/m(2), vincristine 1.1 mg/m(2) and prednisolone 80 mg/day for 5 days) was repeated every 3 weeks. After three cycles of chemotherapy, involved-field radiotherapy was performed with 30-50 Gy in 15-28 fractions.

RESULTS

A total of 24 patients (median age, 75 years; range, 70-84 years) were enrolled. Nineteen patients (79%) had non-bulky tumors <6 cm. The median follow-up period was 7.3 years. The 7-year overall and progression-free survival rates were 78.9% (95% confidence interval, 62.3-95.5) and 65.3% (95% confidence interval, 45.3-85.3), respectively. Six patients developed systemic relapse, two of them after 6 years. The median survival time after relapse was only 5 months (range, 2 weeks-5.2 years). Five patients developed second malignancies, and three other patients died from other causes without lymphoma progression. None of the patients developed local relapse within the radiation field and/or regional relapse in adjacent lymph node areas.

CONCLUSIONS

Although systemic relapses, short survival time after relapse and death from other causes occurred, no loco-regional relapses were observed. Less intensive radiotherapy such as low-dose and small field might not compromise the treatment outcome for this population.