Pinnix Chelsea C, Dabaja Bouthaina, Ahmed Mohamed Amin, Chuang Hubert H, Costelloe Colleen, Wogan Christine F, Reed Valerie, Romaguera Jorge E, Neelapu Sattva, Oki Yasuhiro, Rodriguez M Alma, Fayad Luis, Hagemeister Frederick B, Nastoupil Loretta, Turturro Francesco, Fowler Nathan, Fanale Michelle A, Nieto Yago, Khouri Issa F, Ahmed Sairah, Medeiros L Jeffrey, Davis Richard Eric, Westin Jason
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):113-21. doi: 10.1016/j.ijrobp.2015.02.006.
Excellent outcomes obtained after infusional dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (R-EPOCH) alone have led some to question the role of consolidative radiation therapy (RT) in the treatment of primary mediastinal B cell lymphoma (PMBL). We reviewed the outcomes in patients treated with 1 of 3 rituximab-containing regimens (cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone [R-HCVAD], or R-EPOCH) with or without RT. We also evaluated the ability of positron emission tomography-computed tomography (PET-CT) to identify patients at risk of relapse.
We retrospectively identified 97 patients with diagnoses of stage I/II PMBCL treated at our institution between 2001 and 2013. The clinical characteristics, treatment outcomes, and toxicity were assessed. We analyzed whether postchemotherapy PET-CT could identify patients at risk for progressive disease according to a 5 point scale (5PS) Deauville score assigned.
Among 97 patients (median follow-up time, 57 months), the 5-year overall survival rate was 99%. Of patients treated with R-CHOP, 99% received RT; R-HCVAD, 82%; and R-EPOCH, 36%. Of 68 patients with evaluable end-of-chemotherapy PET-CT scans, 62% had a positive scan (avidity above that of the mediastinal blood pool [Deauville 5PS = 3]), but only 9 patients experienced relapse (n=1) or progressive disease (n=8), all with a 5PS of 4 to 5. Of the 25 patients who received R-EPOCH, 4 experienced progression, all with 5PS of 4 to 5; salvage therapy (RT and autologous stem cell transplantation) was successful in all cases.
Combined modality immunochemotherapy and RT is well tolerated and effective for treatment of PMBCL. A postchemotherapy 5PS of 4 to 5, rather than 3 to 5, can identify patients at high risk of progression who should be considered for therapy beyond chemotherapy alone after R-EPOCH.
单独使用剂量调整的依托泊苷、阿霉素、环磷酰胺、长春新碱、泼尼松和利妥昔单抗（R-EPOCH）后取得的优异疗效，使得一些人质疑巩固性放射治疗（RT）在原发性纵隔B细胞淋巴瘤（PMBL）治疗中的作用。我们回顾了接受含利妥昔单抗的三种方案之一（环磷酰胺、阿霉素、长春新碱、泼尼松[R-CHOP]；超分割环磷酰胺、长春新碱、阿霉素和地塞米松[R-HCVAD]，或R-EPOCH）治疗且接受或未接受RT的患者的治疗结果。我们还评估了正电子发射断层扫描-计算机断层扫描（PET-CT）识别复发风险患者的能力。
我们回顾性确定了2001年至2013年在我们机构接受诊断为I/II期PMBCL治疗的97例患者。评估了临床特征、治疗结果和毒性。我们分析了化疗后PET-CT是否能够根据指定的5分制（5PS）多维尔评分识别疾病进展风险患者。
在97例患者中（中位随访时间57个月），5年总生存率为99%。接受R-CHOP治疗的患者中，99%接受了RT；接受R-HCVAD治疗的患者中，82%接受了RT；接受R-EPOCH治疗的患者中，36%接受了RT。在68例可评估化疗结束时PET-CT扫描的患者中，62%扫描结果为阳性（放射性高于纵隔血池[多维尔5PS=3]），但只有9例患者复发（n=1）或疾病进展（n=8），所有患者的5PS均为4至5。在接受R-EPOCH治疗的25例患者中，4例出现疾病进展，所有患者的5PS均为4至5；挽救性治疗（RT和自体干细胞移植）在所有病例中均成功。
联合免疫化疗和RT对PMBL的治疗耐受性良好且有效。化疗后5PS为4至5而非3至5，可以识别疾病进展高风险患者，这些患者在接受R-EPOCH治疗后应考虑接受除单纯化疗之外的其他治疗。
