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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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Guerini AE, Filippi AR, Tucci A, Simontacchi G, Re A, Guaineri A, Morelli V, Borghetti P, Triggiani L, Pegurri L, Pedretti S, Volpi G, Spiazzi L, Magrini SM, Buglione M. 'Le Roi est mort, vive le Roi': New Roles of Radiotherapy in the Treatment of Lymphomas in Combination With Immunotherapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e135-e148. [PMID: 34728169 DOI: 10.1016/j.clml.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND immunotherapy (IT), including checkpoint inhibitors (CIs) and Chimeric Antigen Receptor T cell therapy (CAR-T) revolutionized the treatment of relapsing or refractory (r/r) lymphoma. Several preliminary experiences evaluated concomitant administration of radiotherapy and IT. METHODS we performed a systematic review of current literature as of March 30, 2020. A total of 1090 records was retrieved, 42 articles were selected on the basis of title and abstract and, after the removal of analyses with no original data or insufficient clinical information, 28 papers were included in the review. RESULTS previous studies were mostly represented by case reports/series or small cohorts. Nonetheless, combination of radiotherapy and CIs or CAR-T led to promising outcomes, resulting in extremely high rates of complete response and improving progression free and overall survival compared with data from recent clinical trials. Combination of RT and CIs had a fair toxicity profile with no reports of severe side effects. Within the limits of the small cohorts retrieved, RT seems a superior option compared with systemic treatment as a 'bridge' to CAR-T and could as well reduce severe complications rates. Radiotherapy could elicit immune response against lymphoma, as demonstrated by multiple cases of abscopal effect and its inclusion in anti-neoplastic vaccines protocols. CONCLUSION The results of this review warrant the evaluation of combination of RT and immunotherapy in larger and preferably prospective and randomized cohorts to confirm these preliminary impressive outcomes. The optimal dose, fractionation and timing of RT still have to be clarified.
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Affiliation(s)
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Alessandra Tucci
- Department of Haematology, ASST-Spedali Civili Hospital, Brescia, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alessandro Re
- Department of Haematology, ASST-Spedali Civili Hospital, Brescia, Italy
| | - Annamaria Guaineri
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Vittorio Morelli
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Ludovica Pegurri
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Sara Pedretti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Giulia Volpi
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy.
| | - Stefano Maria Magrini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Michela Buglione
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
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Abstract
Radiotherapy (RT) plays a diverse and essential role in the contemporary management of non-Hodgkin lymphoma (NHL) and remains the single most powerful monotherapeutic intervention for both aggressive and indolent subtypes. Over the past decade, there have been significant advancements in radiation oncology practice, which have made modern treatments safer and more conformal. Despite this sophistication and evidence supporting a continued role for RT, numerous data suggest that utilization is on the decline. In this review, we discuss the rationale for RT in 4 commonly encountered scenarios: combined modality therapy for limited-stage aggressive NHL, consolidation therapy for advanced-stage aggressive NHL, and the changing roles of salvage RT for relapsed/refractory NHL in an era of new frontiers such as cellular therapies. We also evaluate current strategies to treat indolent histologies. We conclude with perspectives on how RT for the hematological malignancies may continue to evolve.
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Schultz CJ. Reassessing the Role of Radiation Therapy for the Treatment of Lymphoma: Historical Perspective and Opportunities in the Era of Image-Guided and Adaptive Radiation Therapy. J Oncol Pract 2019; 15:175-176. [PMID: 30970226 DOI: 10.1200/jop.19.00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Khan MK, Jiang C, Subramanian K. Radiotherapy Should Be Part of a Multidisciplinary Discussion for Most Patients With Lymphoma. J Oncol Pract 2019; 15:173-174. [DOI: 10.1200/jop.19.00107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Cecilia Jiang
- Emory University Winship Cancer Institute, Atlanta, GA
| | - Kritika Subramanian
- Emory University Winship Cancer Institute, Atlanta, GA
- KU Leuven-University of Leuven, Leuven, Belgium
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