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McLaughlin C, Ricco A, Singh R, Mukhopadhyay N, Skoro N, Girma S, Deng X, Song S. Patient Survival With and Without Radiation Therapy for Early-Stage Diffuse Large B-Cell Lymphoma in the Era of PET and Rituximab. Adv Radiat Oncol 2022; 7:100930. [PMID: 35814857 PMCID: PMC9260098 DOI: 10.1016/j.adro.2022.100930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The benefit of radiation therapy (RT) becomes uncertain in the treatment of early stage diffuse large B-cell lymphoma (DLBCL) in the era of rituximab, positron emission topography (PET), and computed tomography (CT). We sought to retrospectively review modern patients with early stage I-II DLBCL treated with rituximab and staged by PET-CT to better define which patients benefit from consolidative RT. Methods and Materials Patients with early stage I-II DLBCL from 1998 to 2017 were reviewed coinciding with our institutional utilization of rituximab with the standard regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone and PET-CT. Relevant clinical information was used to calculate National Comprehensive Cancer Network international prognostic index (IPI) scores. Kaplan-Meier survival analysis and a Cox proportional hazards model were used for overall survival (OS). Results Seventy-seven patients received chemoimmunotherapy alone, and 41 received chemoimmunotherapy plus RT. Median follow-up time was 9.5 years. On univariate analysis, extranodal disease (P = .04) and National Comprehensive Cancer Network IPI (P < .001) were significantly correlated with OS. Five-year OS was 87% versus 67%, and 10-year OS was 67% versus 58%, numerically higher favoring RT (P = .16). On multivariate Cox regression analysis of OS controlling for IPI and extranodal disease, the addition of RT was associated with improved OS (hazard ratio of 0.4, P = .01). Conclusions The current analysis supports the use of consolidative RT in early stage DLBCL given an OS benefit on multivariate analysis. Further prospective randomized data are needed to confirm these findings.
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Affiliation(s)
- Christopher McLaughlin
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
- Corresponding author: Christopher McLaughlin, MD.
| | - Anthony Ricco
- Department of Radiation, Cancer Informatics Core, Virginia Commonwealth University Health, Richmond, Virginia
| | - Raj Singh
- Department of Radiation, Cancer Informatics Core, Virginia Commonwealth University Health, Richmond, Virginia
| | - Nitai Mukhopadhyay
- Department of Biostatistics, Cancer Informatics Core, Virginia Commonwealth University Health, Richmond, Virginia
| | - Nevena Skoro
- Massey Cancer Center, Cancer Informatics Core, Virginia Commonwealth University Health, Richmond, Virginia
| | - Selamawit Girma
- Massey Cancer Center, Cancer Informatics Core, Virginia Commonwealth University Health, Richmond, Virginia
| | - Xiaoyan Deng
- Department of Biostatistics, Cancer Informatics Core, Virginia Commonwealth University Health, Richmond, Virginia
| | - Shiyu Song
- Department of Radiation, Cancer Informatics Core, Virginia Commonwealth University Health, Richmond, Virginia
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Ge J, Xia Y, Sun Z, Zhang L, Li X, Li L, Wang X, Zhang X, Li Z, Nan F, Wan W, Xu D, Ding J, Fu X, Zhang M. Improving outcomes in limited-stage de novo CD5+ DLBCL: systemic approaches with consolidative radiation. Leuk Lymphoma 2022; 63:1369-1374. [PMID: 34989286 DOI: 10.1080/10428194.2021.2023742] [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: 10/19/2022]
Abstract
CD5-positive diffuse large B-cell lymphoma (CD5+ DLBCL) is characterized by poor prognosis after frontline immunochemotherapy. This retrospective study investigated the effect of consolidative radiation after systemic treatment in newly diagnosed stage I-II de novo CD5+ DLBCL. In this study, 22 patients received consolidative radiotherapy (RT) after immunochemotherapy (chemotherapy + RT group) and 28 patients received chemotherapy alone. Patients who received chemotherapy alone had a significantly shorter PFS and OS than those who received consolidative radiotherapy. The five-year PFS rates for the chemotherapy + RT and chemotherapy alone groups were 75.1% and 40.5%, respectively. The five-year OS rates for the chemotherapy + RT and chemotherapy alone groups were 84.2% and 50.1%, respectively. Even after receiving consolidation radiotherapy, 2/22 (9.1%) patients experienced CNS relapse. Age >60 years and lack of radiotherapy were independent prognostic factors for PFS and OS. Ki-67 (≥80%) was an independent prognostic factor for poor OS. Consolidative radiotherapy might be a good option for stage I-II CD5+ DLBCL, but further investigation is needed.
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Affiliation(s)
- Jurui Ge
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Yaqin Xia
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Zhenchang Sun
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Lei Zhang
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Xin Li
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Ling Li
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Xinhua Wang
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Xudong Zhang
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Zhaoming Li
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Feifei Nan
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Wenjuan Wan
- Oncology Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Duo Xu
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Jiayin Ding
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - XiaoRui Fu
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
| | - Mingzhi Zhang
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, China
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3
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Peng C, Ho J, Bai HX, Huang Y, Huang RY, Yang L. Adjuvant radiotherapy and chemotherapy in early-stage diffuse large B cell lymphoma of head and neck with extranodal involvement. Hematology 2019; 24:268-275. [PMID: 31793408 DOI: 10.1080/16078454.2019.1565148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Cuiying Peng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Joshua Ho
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harrison X. Bai
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yuqian Huang
- Department of Neurology, The First Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Raymond Y. Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Li Yang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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5
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R-CHOP 14 with or without radiotherapy in nonbulky limited-stage diffuse large B-cell lymphoma. Blood 2017; 131:174-181. [PMID: 29061568 DOI: 10.1182/blood-2017-07-793984] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
The benefit of radiotherapy (RT) after chemotherapy in limited-stage diffuse large B-cell lymphoma (DLBCL) remains controversial. We conducted a randomized trial in patients with nonbulky limited-stage DLBCL to evaluate the benefit of RT after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Patients were stratified according to the modified International Prognostic Index, including lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, age, and disease stage. The patients received 4 or 6 consecutive cycles of R-CHOP delivered once every 2 weeks, followed or not by RT at 40 Gy delivered 4 weeks after the last R-CHOP cycle. All patients were evaluated by fluorodeoxyglucose-positron emission tomography scans performed at baseline, after 4 cycles of R-CHOP, and at the end of treatment. The primary objective of the trial was event-free survival (EFS) from randomization. The trial randomly assigned 165 patients in the R-CHOP arm and 169 in the R-CHOP plus RT arm. In an intent-to-treat analysis with a median follow-up of 64 months, 5-year EFS was not statistically significantly different between the 2 arms, with 89% ± 2.9% in the R-CHOP arm vs 92% ± 2.4% in the R-CHOP plus RT arm (hazard ratio, 0.61; 95% confidence interval [CI], 0.3-1.2; P = .18). Overall survival was also not different at 92% (95% CI, 89.5%-94.5%) for patients assigned to R-CHOP alone and 96% (95% CI, 94.3%-97.7%) for those assigned to R-CHOP plus RT (P = not significant). R-CHOP alone is not inferior to R-CHOP followed by RT in patients with nonbulky limited-stage DLBCL. This trial was registered at www.clinicaltrials.gov as #NCT00841945.
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Giné E, Sehn LH. Diffuse Large B-Cell Lymphoma: Should Limited-Stage Patients Be Treated Differently? Hematol Oncol Clin North Am 2016; 30:1179-1194. [PMID: 27888874 DOI: 10.1016/j.hoc.2016.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diffuse large B-cell lymphoma presents as limited-stage disease in approximately 30% of cases. Historically, therapy relied on a combined modality of abbreviated chemotherapy followed by involved-field radiotherapy (IFRT). Due to the apparent lack of long-term survival and the concern for delayed toxicity, chemotherapy-only strategies are used more frequently. Treatment should take into account patient performance, clinical risks, and involvement sites. PET-guided approaches are being investigated. The risk of late relapse has been recognized, highlighting the importance of long-term follow-up. Future efforts must incorporate biological features to improve risk assessment, guide clinical decisions, and achieve an individualized therapy.
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Affiliation(s)
- Eva Giné
- Hospital Clínic of Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 08036 Barcelona, Spain
| | - Laurie H Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, 600 West 10th avenue, Vancouver, BC V5Z 4E6, Canada.
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Ng AK, Dabaja BS, Hoppe RT, Illidge T, Yahalom J. Re-Examining the Role of Radiation Therapy for Diffuse Large B-Cell Lymphoma in the Modern Era. J Clin Oncol 2016; 34:1443-7. [DOI: 10.1200/jco.2015.64.9418] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrea K. Ng
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Timothy Illidge
- University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
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