Department of Radiation Oncology, Emory University, Atlanta, GA 30322, USA.
Int J Radiat Oncol Biol Phys. 2013 Jul 1;86(3):569-77. doi: 10.1016/j.ijrobp.2013.02.007. Epub 2013 Mar 26.
The role of consolidative radiation therapy (RT) after complete response (CR) to rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for stage III-IV diffuse large B-cell lymphoma (DLBCL) patients is unclear. We aimed to evaluate our institutional experience when consolidative RT is delivered to initial presenting sites or bulky sites in these patients.
We identified 211 histologically confirmed stage III-IV DLBCL patients who received R-CHOP from January 2000 to May 2012 at our institution. Patterns of failure for patients who achieved CR to R-CHOP were analyzed. Local control (LC), distant control (DC), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier method and compared between patients who received R-CHOP alone versus R-CHOP plus consolidative RT using the log-rank test. Multivariate analyses were also performed using Cox proportional hazards model.
Detailed treatment records were available for 163 patients. After a median 6 cycles of R-CHOP, 110 patients (67.5%) achieved CR and were entered for analysis. Fourteen patients (12.7%) received consolidative RT. After median follow-up of 32.9 months, 43.8% of patients who received R-CHOP alone failed at the initial sites with or without distant recurrence (DR), whereas isolated DR only occurred in 3.7% of these patients. Consolidative RT was associated with significantly improved LC (91.7% vs 48.8%), DC (92.9% vs 71.9%), PFS (85.1% vs 44.2%), and OS (92.3% vs 68.5%; all Ps<.0001) at 5 years compared with patients with R-CHOP alone. On multivariate analysis, consolidative RT and nonbulky disease were predictive of increased LC and PFS, whereas bone marrow involvement was associated with increased risk of DR and worse OS. Consolidative RT was also associated with marginal improved OS.
Forty-four percent of patients with advanced stage DLBCL failed at initial presenting sites after achieving CR to R-CHOP. Incorporation of consolidative RT as part of upfront treatment in these patients was associated with improved LC, PFS, and a trend towards improved OS.
对于接受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）治疗达到完全缓解（CR）的 III-IV 期弥漫性大 B 细胞淋巴瘤（DLBCL）患者，巩固性放疗（RT）的作用尚不清楚。我们旨在评估在这些患者中，当给予初始受累部位或大肿块部位的巩固性 RT 时，我们机构的经验。
我们在本机构确定了 211 例经组织学证实的 III-IV 期 DLBCL 患者，他们在 2000 年 1 月至 2012 年 5 月期间接受了 R-CHOP 治疗。分析了达到 R-CHOP 治疗 CR 的患者的失败模式。采用 Kaplan-Meier 法估计无局部失败率（LC）、无远处失败率（DC）、无进展生存率（PFS）和总生存率（OS），并采用对数秩检验比较单纯接受 R-CHOP 治疗与 R-CHOP 联合巩固性 RT 治疗的患者之间的差异。采用 Cox 比例风险模型进行多变量分析。
详细的治疗记录可用于 163 例患者。在接受中位数为 6 个周期的 R-CHOP 治疗后，110 例（67.5%）患者达到 CR 并纳入分析。14 例（12.7%）患者接受了巩固性 RT。在中位随访 32.9 个月后，单纯接受 R-CHOP 治疗的患者中有 43.8%在初始部位出现或不出现远处复发（DR）失败，而这些患者中仅有 3.7%出现孤立性 DR。与单纯接受 R-CHOP 治疗的患者相比，接受巩固性 RT 的患者具有显著改善的无局部失败率（91.7% vs 48.8%）、无远处失败率（92.9% vs 71.9%）、无进展生存率（85.1% vs 44.2%）和总生存率（92.3% vs 68.5%；均 P<.0001），在 5 年时。多变量分析表明，巩固性 RT 和非肿块疾病是无局部失败率和无进展生存率的预测因素，而骨髓受累与 DR 风险增加和总生存率降低相关。巩固性 RT 也与总生存率的边际改善相关。
44%的接受 R-CHOP 治疗达到完全缓解的晚期 DLBCL 患者在初始部位失败。在这些患者中，将巩固性 RT 作为一线治疗的一部分，可以改善无局部失败率、无进展生存率，并改善总生存率。
