Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York 14642, USA.
Int J Radiat Oncol Biol Phys. 2010 May 1;77(1):79-85. doi: 10.1016/j.ijrobp.2009.04.036. Epub 2009 Aug 3.
For patients with recurrent or refractory large B-cell non-Hodgkin's lymphoma, high-dose chemotherapy and autologous stem cell transplant (ASCT) is the treatment of choice. We evaluated the role of involved field radiation therapy (IFRT) post-ASCT for patients initially induced with cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) or, more recently, rituximab-CHOP (R-CHOP).
Between May 1992 and April 2005, 176 patients underwent ASCT for recurrent or refractory large B-cell non-Hodgkin's lymphoma; 164 patients were evaluable for endpoint analysis. Fifty percent of the CHOP group (n = 131), and 39% of the R-CHOP group (n = 33), received IFRT. Follow-up from the time of transplant was a median/mean of 1.7/3 years (range, 0.03-13 years).
The 5-year overall survival (OS) and disease-specific survival (DSS) improved with IFRT in both the R-CHOP (p = 0.006 and 0.02, respectively) and CHOP (p = 0.02 and p = 0.04, respectively) groups. IFRT was associated with a 10% (p = 0.17) reduction in local failure, alone or with a distant site. On univariate analysis, IFRT was associated with superior OS (hazard ratio [HR] = 0.50 [95% CI 0.32, 0.78]; p = 0.002) and DSS (HR = 0.53 [95% CI 0.33, 0.86]; p = 0.009). Presence of B symptoms was adverse (p = 0.03). On multivariate analysis, only IFRT was associated with significant improvement in OS (HR = 0.35 [0.18, 0.68]; p = 0.002) and DSS (HR = 0.39 [95% CI 0.18, 0.84]; p = 0.01).
Recognizing that positive and negative patient selection bias exists for the use of IFRT post-ASCT, patients initially treated with CHOP or R-CHOP and who undergo ASCT for recurrent or refractory disease may benefit from subsequent IFRT presumably due to enhanced local control that can translate into a survival advantage.
对于复发或难治性大 B 细胞非霍奇金淋巴瘤患者，大剂量化疗和自体干细胞移植（ASCT）是首选治疗方法。我们评估了 ASCT 后受累野放疗（IFRT）在最初接受环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）诱导或最近接受利妥昔单抗-CHOP（R-CHOP）诱导的患者中的作用。
1992 年 5 月至 2005 年 4 月，176 例患者因复发或难治性大 B 细胞非霍奇金淋巴瘤接受 ASCT；164 例患者可进行终点分析。CHOP 组的 50%（n=131）和 R-CHOP 组的 39%（n=33）接受了 IFRT。从移植时起的中位/平均随访时间为 1.7/3 年（范围，0.03-13 年）。
R-CHOP 组（p=0.006 和 0.02）和 CHOP 组（p=0.02 和 p=0.04）中，IFRT 可改善 5 年总生存率（OS）和疾病特异性生存率（DSS）。IFRT 可单独或联合远处部位降低局部失败率 10%（p=0.17）。单因素分析显示，IFRT 与 OS 改善相关（风险比[HR]为 0.50[95%CI 0.32, 0.78]；p=0.002）和 DSS（HR 为 0.53[95%CI 0.33, 0.86]；p=0.009）。存在 B 症状是不利的（p=0.03）。多因素分析显示，只有 IFRT 与 OS（HR=0.35[0.18, 0.68]；p=0.002）和 DSS（HR=0.39[95%CI 0.18, 0.84]；p=0.01）的显著改善相关。
鉴于在 ASCT 后使用 IFRT 存在阳性和阴性患者选择偏倚，最初接受 CHOP 或 R-CHOP 治疗且因复发或难治性疾病接受 ASCT 的患者可能受益于随后的 IFRT，可能是因为增强局部控制可转化为生存优势。
