Lee Jessica W, Prosnitz Leonard R, Stefanovic Alexandra, Kelsey Chris R
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina.
Adv Radiat Oncol. 2019 Mar 30;4(3):507-512. doi: 10.1016/j.adro.2019.03.010. eCollection 2019 Jul-Sep.
This study aimed to evaluate whether higher doses of consolidation radiation therapy (RT), which have been traditionally recommended for osseous sites in diffuse large B-cell lymphoma (DLBCL), are still necessary.
Patients with DLBCL with osseous involvement treated with first-line chemotherapy followed by consolidation RT between 1995 and 2016 were reviewed. The primary endpoint was 5-year freedom from local recurrence, estimated using the Kaplan-Meier method. Outcomes based on the RT dose received were also assessed.
A total of 51 patients were identified. The most common chemotherapy regimens were rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (80%) and cyclophosphamide, doxorubicin, vincristine, and prednisone (12%) with a median of 6 cycles (range, 3-8 cycles). After chemotherapy, 82% of patients achieved a complete response (CR), and 18% achieved a partial response (PR). All patients in PR were deemed appropriate for consolidation RT. The median dose was 29 Gy (24 Gy for CR; 36 Gy for PR). After a median follow-up of 86 months, 8 patients relapsed, with 2 relapses in the RT field after consolidation RT of 30 and 39.6 Gy, respectively. Overall, the 5-year freedom from local recurrence was 96% (95% confidence interval [CI], 91%-100%), disease-free survival was 76% (95% CI, 65%-89%), and overall survival was 86% (95% CI, 76%-96%). No dose-response relationship was observed.
In patients with DLBCL with osseous involvement who achieved a CR after first-line chemotherapy, 20 to 30 Gy of consolidation RT led to high rates of local control. Higher doses should be reserved for patients in PR.
本研究旨在评估传统上推荐用于弥漫性大B细胞淋巴瘤（DLBCL）骨转移部位的高剂量巩固放疗（RT）是否仍然必要。
回顾了1995年至2016年间接受一线化疗后进行巩固放疗的骨转移DLBCL患者。主要终点是5年局部无复发生存率，采用Kaplan-Meier方法估计。还评估了基于所接受放疗剂量的结果。
共确定了51例患者。最常见的化疗方案是利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（80%）以及环磷酰胺、多柔比星、长春新碱和泼尼松（12%），中位周期数为6个周期（范围3 - 8个周期）。化疗后，82%的患者达到完全缓解（CR），18%的患者达到部分缓解（PR）。所有PR患者均被认为适合进行巩固放疗。中位剂量为29 Gy（CR患者为24 Gy；PR患者为36 Gy）。中位随访86个月后，8例患者复发，分别在接受30 Gy和39.6 Gy巩固放疗后，放疗区域内有2例复发。总体而言，5年局部无复发生存率为96%（95%置信区间[CI]，91% - 100%），无病生存率为76%（95% CI，65% - 89%），总生存率为86%（95% CI，76% - 96%）。未观察到剂量反应关系。
在一线化疗后达到CR的骨转移DLBCL患者中，20至30 Gy的巩固放疗可实现较高的局部控制率。更高剂量应保留给PR患者。
