Holzhäuser Eva, Berlin Maximilian, Wollschläger Daniel, Bezold Thomas, Mayer Arnulf, Heß Georg, Schmidberger Heinz
Department of Radiation Oncology and Radiotherapy, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany.
Strahlenther Onkol. 2017 Dec;193(12):1014-1023. doi: 10.1007/s00066-017-1186-x. Epub 2017 Jul 26.
Radiotherapy (RT) in combination with chemoimmunotherapy is highly efficient in the treatment of diffuse large B‑cell lymphoma (DLBCL). This retrospective analysis evaluated the efficacy of the treatment volume and the dose concept of involved-site RT (ISRT).
We identified 60 histologically confirmed stage I-IV DLBCL patients treated with multimodal cytotoxic chemoimmunotherapy and followed by consolidative ISRT from 2005-2015. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method. Univariate analyses were performed by log-rank test and Mann-Whitney U‑test.
After initial chemoimmunotherapy (mostly R‑CHOP; rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), 19 (36%) patients achieved complete response (CR), 34 (64%) partial response (PR) or less. Excluded were 7 (12%) patients with progressive disease after chemoimmunotherapy. All patients underwent ISRT with a dose of 40 Gy. After a median follow-up of 44 months, 79% of the patients remained disease free, while 21% presented with failure, progressive systemic disease, or death. All patients who achieved CR after chemoimmunotherapy remained in CR. Of the patients achieving PR after chemotherapy only 2 failed at the initial site within the ISRT volume. No marginal relapse was observed. Ann Arbor clinical stage I/II showed significantly improved PFS compared to stage III/IV (93% vs 65%; p ≤ 0.021). International Prognostic Index (IPI) score of 0 or 1 compared to 2-5 has been associated with significantly increased PFS (100% vs 70%; p ≤ 0.031). Postchemoimmunotherapy status of CR compared to PR was associated with significantly increased PFS (100% vs 68%; p ≤ 0.004) and OS (100% vs 82%; p ≤ 0.026). Only 3 of 53 patients developed grade II late side effects, whereas grade III or IV side effects have not been observed.
These data suggest that a reduction of the RT treatment volume from involved-field (IF) to involved-site (IS) is sufficient because no marginal failures occurred. The concept of IS will likely reduce the risk for late sequelae of RT.
放射治疗（RT）联合化学免疫疗法在弥漫性大B细胞淋巴瘤（DLBCL）治疗中具有高效性。本回顾性分析评估了受累部位放疗（ISRT）的治疗体积和剂量方案的疗效。
我们确定了60例经组织学确诊为I-IV期DLBCL的患者，这些患者在2005年至2015年期间接受了多模式细胞毒性化学免疫疗法，随后接受巩固性ISRT。采用Kaplan-Meier法估计无进展生存期（PFS）和总生存期（OS）。通过对数秩检验和Mann-Whitney U检验进行单因素分析。
初始化学免疫疗法（大多为R-CHOP；利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松龙）后，19例（36%）患者达到完全缓解（CR），34例（64%）为部分缓解（PR）或更低。排除7例（12%）化学免疫疗法后疾病进展的患者。所有患者均接受了40 Gy剂量的ISRT。中位随访44个月后，79%的患者无疾病，而21%的患者出现失败、进行性全身疾病或死亡。化学免疫疗法后达到CR的所有患者均保持CR状态。化疗后达到PR的患者中，仅2例在ISRT体积内的初始部位出现失败。未观察到边缘复发。Ann Arbor临床I/II期与III/IV期相比，PFS显著改善（93%对65%；p≤0.021）。国际预后指数（IPI）评分为0或1与评分为2-5相比，PFS显著增加（100%对70%；p≤0.031）。化学免疫疗法后CR状态与PR相比，PFS（100%对68%；p≤0.004）和OS（100%对82%；p≤0.026）显著增加。53例患者中仅3例出现II级晚期副作用，未观察到III级或IV级副作用。
这些数据表明，将RT治疗体积从受累野（IF）减少到受累部位（IS）就足够了，因为未发生边缘失败。IS方案可能会降低RT晚期后遗症的风险。
