The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
J Clin Oncol. 2010 Sep 20;28(27):4170-6. doi: 10.1200/JCO.2009.27.3441. Epub 2010 Aug 16.
The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The role of consolidative radiation therapy (RT) in the setting of R-CHOP chemotherapy is not well reported. This retrospective analysis is an attempt to clarify this role.
Subjects were 469 patients with histologically confirmed DLBCL treated between January 2001 and December 2007. Variables including age, sex, Ann Arbor disease stage, bulky disease status, standardized uptake values (SUVs) on positron emission tomography (PET), International Prognostic Index (IPI), and Ki67 staining (proliferation).
Of 469 patients, 190 (40.5%) had stage I or II disease and 279 (59.5%) had stage III or IV disease, 327 (70%) had at least six cycles of R-CHOP, and 142 (30.2%) had involved-field RT (dose, 30 to 39.6 Gy) after complete response to chemotherapy. Median follow-up was 36 months (range, 8 to 85 months). Multivariate analysis showed that RT (P < .0001), IPI score (P = .001), response to therapy (P = .001), use of six to eight cycles of R-CHOP (P < .001), and combined presence (P = .006) or absence (P = .025) of high Ki67, high PET SUV, and bulky disease influenced overall survival (OS) and progression-free survival (PFS). Matched-pair analyses of patients who received six to eight cycles of R-CHOP with stage I or II disease (44 pairs) and all stages (74 pairs) indicated that RT improved OS (hazard ratio [HR], 0.52 and 0.29, respectively) and PFS (HR, 0.45 and 0.24, respectively) compared with no RT.
This study showed significant improvements in OS and PFS among patients who received consolidation RT after R-CHOP chemotherapy for DLBCL.
弥漫性大 B 细胞淋巴瘤（DLBCL）患者的标准治疗方法是利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）。R-CHOP 化疗中联合巩固性放疗（RT）的作用尚未得到充分报道。本回顾性分析旨在阐明这一作用。
本研究纳入了 2001 年 1 月至 2007 年 12 月期间接受组织学确诊的 DLBCL 治疗的 469 例患者。变量包括年龄、性别、Ann Arbor 疾病分期、肿块状态、正电子发射断层扫描（PET）的标准化摄取值（SUV）、国际预后指数（IPI）和 Ki67 染色（增殖）。
469 例患者中，190 例（40.5%）为Ⅰ或Ⅱ期疾病，279 例（59.5%）为Ⅲ或Ⅳ期疾病，327 例（70%）接受了至少 6 个周期的 R-CHOP 治疗，142 例（30.2%）在化疗完全缓解后接受了累及野 RT（剂量 30 至 39.6 Gy）。中位随访时间为 36 个月（范围 8 至 85 个月）。多变量分析显示，RT（P＜0.0001）、IPI 评分（P=0.001）、治疗反应（P=0.001）、使用 6 至 8 个周期的 R-CHOP（P＜0.001）以及高 Ki67、高 PET SUV 和肿块的联合存在（P=0.006）或不存在（P=0.025）均影响总生存（OS）和无进展生存（PFS）。对接受 6 至 8 个周期 R-CHOP 治疗且 I 期或Ⅱ期疾病（44 对）和所有分期（74 对）的患者进行配对分析显示，与未接受 RT 相比，RT 可改善 OS（风险比[HR]分别为 0.52 和 0.29）和 PFS（HR 分别为 0.45 和 0.24）。
本研究表明，在接受 R-CHOP 化疗治疗的 DLBCL 患者中，接受 R-CHOP 化疗后行巩固性 RT 可显著改善 OS 和 PFS。
