Tao Randa, Allen Pamela K, Rodriguez Alma, Shihadeh Ferial, Pinnix Chelsea C, Arzu Isadora, Reed Valerie K, Oki Yasuhiro, Westin Jason R, Fayad Luis E, Medeiros L Jeffrey, Dabaja Bouthaina
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):122-9. doi: 10.1016/j.ijrobp.2015.01.014. Epub 2015 Mar 5.
Outcomes for patients with diffuse large B-cell lymphoma (DLBCL) differ according to the site of presentation. With effective chemotherapy, the need for consolidative radiation therapy (RT) is controversial. We investigated the influence of primary bone presentation and receipt of consolidative RT on progression-free survival (PFS) and overall survival (OS) in patients with DLBCL.
We identified 102 patients with primary bone DLBCL treated consecutively from 1988 through 2013 and extracted clinical, pathologic, and treatment characteristics from the medical records. Survival outcomes were calculated by the Kaplan-Meier method, with factors affecting survival determined by log-rank tests. Univariate and multivariate analyses were done with a Cox regression model.
The median age was 55 years (range, 16-87 years). The most common site of presentation was in the long bones. Sixty-five patients (63%) received R-CHOP-based chemotherapy, and 74 (72%) received rituximab. RT was given to 67 patients (66%), 47 with stage I to II and 20 with stage III to IV disease. The median RT dose was 44 Gy (range, 24.5-50 Gy). At a median follow-up time of 82 months, the 5-year PFS and OS rates were 80% and 82%, respectively. Receipt of RT was associated with improved 5-year PFS (88% RT vs 63% no RT, P=.0069) and OS (91% vs 68%, P=.0064). On multivariate analysis, the addition of RT significantly improved PFS (hazard ratio [HR] = 0.14, P=.014) with a trend toward an OS benefit (HR=0.30, P=.053). No significant difference in PFS or OS was found between patients treated with 30 to 35 Gy versus ≥ 36 Gy (P=.71 PFS and P=.31 OS).
Patients with primary bone lymphoma treated with standard chemotherapy followed by RT can have excellent outcomes. The use of consolidative RT was associated with significant benefits in both PFS and OS.
弥漫性大B细胞淋巴瘤（DLBCL）患者的预后因发病部位而异。在有效的化疗之后，巩固性放射治疗（RT）的必要性存在争议。我们研究了原发性骨发病情况以及接受巩固性RT对DLBCL患者无进展生存期（PFS）和总生存期（OS）的影响。
我们确定了1988年至2013年连续治疗的102例原发性骨DLBCL患者，并从病历中提取了临床、病理和治疗特征。生存结果采用Kaplan-Meier方法计算，通过对数秩检验确定影响生存的因素。使用Cox回归模型进行单因素和多因素分析。
中位年龄为55岁（范围16 - 87岁）。最常见的发病部位是长骨。65例患者（63%）接受了基于R-CHOP的化疗，74例（72%）接受了利妥昔单抗治疗。67例患者（66%）接受了RT，其中47例为Ⅰ至Ⅱ期，20例为Ⅲ至Ⅳ期疾病。中位RT剂量为44 Gy（范围24.5 - 50 Gy）。中位随访时间为82个月时，5年PFS率和OS率分别为80%和82%。接受RT与5年PFS改善相关（RT组为88%，未接受RT组为63%，P = 0.0069）以及OS改善相关（91%对68%，P = 0.0064）。多因素分析显示，添加RT显著改善了PFS（风险比[HR] = 0.14，P = 0.014），有OS获益的趋势（HR = 0.30，P = 0.053）。接受30至35 Gy与≥36 Gy治疗的患者在PFS或OS方面未发现显著差异（PFS为P = 0.71，OS为P = 0.31）。
接受标准化疗后再进行RT治疗的原发性骨淋巴瘤患者可获得良好的预后。使用巩固性RT在PFS和OS方面均有显著益处。
