BC Cancer - Vancouver, University of British Columbia.
BC Cancer - Vancouver, University of British Columbia; BC Cancer - Vancouver, BC Cancer Center for Lymphoid Cancer, University of British Columbia.
Pract Radiat Oncol. 2021 Mar-Apr;11(2):e203-e209. doi: 10.1016/j.prro.2020.11.003. Epub 2020 Nov 13.
The study objective was to investigate the effectiveness of palliative radiation therapy (RT) for patients with diffuse large B-cell lymphoma (DLBCL) and to identify factors, such as chemotherapy relapsed/refractory (R/R) disease, that may influence RT outcomes.
Patients with DLBCL who received palliative RT from 2001 to 2015 in British Columbia were reviewed for patient characteristics, treatment details, and outcomes. Univariable and multivariable analyses for response and local progression were performed.
Three-hundred and seventy courses of palliative RT in 217 patients were identified. Median equivalent dose in 2 Gy fractions was 19 Gy (range, 2-42 Gy). Clinical and/or radiologic response occurred in 230 (83%) of the 276 courses with response data available. Local control following palliative RT at 6 months was 66.7%. On univariable analysis, R/R disease was not associated with lower clinical response rates but had higher risk of progression (hazard ratio [HR], 0.5; P = .040). On multivariable analyses, patients with R/R disease who did not require concurrent steroids had greater response compared with those who received upfront palliative RT (odds ratio, 3.5; P = .011). Response to first-line chemotherapy and smaller lesion size were associated with improved local progression rates (HR, 0.2; P < .001 and HR, 0.5; P = .020, respectively). RT dose fractionation factors were not significant on any analyses.
Palliative RT for DLBCL is effective for symptom improvement, including in the chemotherapy R/R setting. Not requiring concurrent steroids, response to first-line chemotherapy, and smaller lesion size predicted better RT outcomes. There was no association between dose fractionation and response rates or local control to suggest that higher RT doses are more effective for palliation.
本研究旨在探讨姑息性放疗（RT）对弥漫性大 B 细胞淋巴瘤（DLBCL）患者的疗效，并确定可能影响 RT 结果的因素，如化疗复发/难治（R/R）疾病。
对 2001 年至 2015 年在不列颠哥伦比亚省接受姑息性 RT 的 DLBCL 患者的患者特征、治疗细节和结果进行回顾性分析。对反应和局部进展进行单变量和多变量分析。
共确定 217 例患者 370 例次姑息性 RT。2 Gy 剂量等效剂量中位数为 19 Gy（范围 2-42 Gy）。有 276 例次可获得反应数据，其中 230 例次（83%）出现临床或放射学反应。姑息性 RT 后 6 个月局部控制率为 66.7%。单变量分析显示，R/R 疾病与较低的临床反应率无关，但进展风险较高（风险比 [HR]，0.5；P =.040）。多变量分析显示，未接受同期类固醇治疗的 R/R 疾病患者的反应率高于接受一线姑息性 RT 的患者（比值比，3.5；P =.011）。对一线化疗的反应和较小的病变大小与改善局部进展率相关（HR，0.2；P <.001 和 HR，0.5；P =.020）。RT 剂量分割因素在任何分析中均无显著性。
DLBCL 的姑息性 RT 对症状改善有效，包括在化疗 R/R 环境中。不使用同期类固醇、对一线化疗的反应和较小的病变大小预测了更好的 RT 结果。剂量分割与反应率或局部控制之间没有关联，表明更高的 RT 剂量对缓解更有效。
