Hu Chunhong, Deng Chao, Zou Wen, Zhang Guangsen, Wang Jingjing
Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, PR China.
Acta Haematol. 2015;134(2):111-8. doi: 10.1159/000370096. Epub 2015 Apr 22.
The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP). The role of radiotherapy (RT) after complete response (CR) to RCHOP in patients with DLBCL remains unclear. This systematic review with a meta-analysis is an attempt to evaluate this role.
Studies that evaluated RT versus no-RT after CR to RCHOP for DLBCL patients were searched in databases. Hazard ratios (HR) with their respective 95% confidence intervals (CI) were calculated using a random-effects model.
A total of 4 qualified retrospective studies (633 patients) were included in this review. The results suggested that RT improved overall survival (OS; HR 0.33, 95% CI 0.14-0.77) and progression-free/event-free survival (PFS/EFS; HR 0.24, 95% CI 0.11-0.50) in all patients compared with no-RT. In a subgroup analysis of patients with stage III-IV DLBCL, RT improved PFS/EFS (HR 0.19, 95% CI 0.07-0.51) and local control (HR 0.12, 95% CI 0.03-0.44), with a trend of improving OS (HR 0.35, 95% CI 0.12-1.05).
Consolidation RT could significantly improve outcomes of DLBCL patients who achieved a CR to RCHOP. However, the significance of these results was limited by these retrospective data. Further investigation of the role of consolidation RT in the rituximab era is needed.
弥漫性大B细胞淋巴瘤（DLBCL）患者目前的标准治疗方案是利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（RCHOP）。DLBCL患者对RCHOP完全缓解（CR）后放疗（RT）的作用仍不明确。本系统评价及荟萃分析旨在评估这一作用。
在数据库中检索评估DLBCL患者对RCHOP达到CR后放疗与不放疗的研究。采用随机效应模型计算风险比（HR）及其各自的95%置信区间（CI）。
本评价共纳入4项合格的回顾性研究（633例患者）。结果表明，与不放疗相比，放疗可改善所有患者的总生存期（OS；HR 0.33，95%CI 0.14 - 0.77）和无进展生存期/无事件生存期（PFS/EFS；HR 0.24，95%CI 0.11 - 0.50）。在III-IV期DLBCL患者的亚组分析中，放疗改善了PFS/EFS（HR 0.19，95%CI 0.07 - 0.51）和局部控制率（HR 0.12，95%CI 0.03 - 0.44），有改善OS的趋势（HR 0.35，95%CI 0.12 - 1.05）。
巩固性放疗可显著改善对RCHOP达到CR的DLBCL患者的预后。然而，这些回顾性数据限制了这些结果的意义。需要进一步研究巩固性放疗在利妥昔单抗时代的作用。
