Kwon Jeanny, Kim Il Han, Kim Byoung Hyuck, Kim Tae Min, Heo Dae Seog
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):91-8. doi: 10.1016/j.ijrobp.2014.12.042. Epub 2015 Feb 24.
The purpose of this study was to evaluate the role of involved-lesion radiation therapy (ILRT) after rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in limited stage diffuse large B-cell lymphoma (DLBCL) by comparing outcomes of R-CHOP therapy alone with R-CHOP followed by ILRT.
We identified 198 patients treated with R-CHOP (median, 6 cycles) for pathologically confirmed DLBCL of limited stage from July 2004 to December 2012. Clinical characteristics of these patients were 33% with stage I and 66.7% with stage II; 79.8% were in the low or low-intermediate risk group; 13.6% had B symptoms; 29.8% had bulky tumors (≥ 7 cm); and 75.3% underwent ≥ 6 cycles of R-CHOP therapy. RT was given to 43 patients (21.7%) using ILRT technique, which included the prechemotherapy tumor volume with a median margin of 2 cm (median RT dose: 36 Gy).
After a median follow-up of 40 months, 3-year progression-free survival (PFS) and overall survival (OS) were 85.8% and 88.9%, respectively. Multivariate analysis showed ≥ 6 cycles of R-CHOP (PFS, P=.004; OS, P=.004) and ILRT (PFS, P=.021; OS, P=.014) were favorable prognosticators of PFS and OS. A bulky tumor (P=.027) and response to R-CHOP (P=.012) were also found to be independent factors of OS. In subgroup analysis, the effect of ILRT was prominent in patients with a bulky tumor (PFS, P=.014; OS, P=.030) or an elevated level of serum lactate dehydrogenase (LDH; PFS, P=.004; OS, P=.012).
Our results suggest that ILRT after R-CHOP therapy improves PFS and OS in patients with limited stage DLBCL, especially in those with bulky disease or an elevated serum LDH level.
本研究旨在通过比较单纯利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）化疗与R-CHOP化疗后联合受累野放射治疗（ILRT）的疗效，评估ILRT在局限期弥漫性大B细胞淋巴瘤（DLBCL）治疗中的作用。
我们纳入了198例2004年7月至2012年12月期间接受R-CHOP（中位6个周期）治疗的经病理确诊的局限期DLBCL患者。这些患者的临床特征为：I期占33%，II期占66.7%；79.8%为低或低中危组；13.6%有B症状；29.8%有大包块肿瘤（≥7 cm）；75.3%接受了≥6个周期的R-CHOP治疗。43例患者（21.7%）采用ILRT技术进行放疗，包括化疗前肿瘤体积，中位边缘为2 cm（中位放疗剂量：36 Gy）。
中位随访40个月后，3年无进展生存期（PFS）和总生存期（OS）分别为85.8%和88.9%。多因素分析显示，≥6个周期的R-CHOP（PFS，P = 0.004；OS，P = 0.004）和ILRT（PFS，P = 0.021；OS，P = 0.014）是PFS和OS的有利预后因素。大包块肿瘤（P = 0.027）和对R-CHOP的反应（P = 0.012）也是OS的独立因素。亚组分析中，ILRT在有大包块肿瘤（PFS，P = 0.014；OS，P = 0.030）或血清乳酸脱氢酶（LDH）水平升高（PFS，P = 0.004；OS，P = 0.012）的患者中效果显著。
我们的结果表明，R-CHOP治疗后联合ILRT可改善局限期DLBCL患者的PFS和OS，尤其是在有大包块疾病或血清LDH水平升高的患者中。
