Hong Ji Hyun, Lee Han Hee, Jung Seung-Eun, Park Gyeongsin, O Joo-Hyun, Jeon Young-Woo, Choi Byung-Ock, Cho Seok-Goo
Department of Radiation Oncology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Gastroenterology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Front Oncol. 2021 Feb 22;11:578865. doi: 10.3389/fonc.2021.578865. eCollection 2021.
The role of consolidative radiotherapy (RT) after complete-remission (CR) following rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in advanced-stage diffuse large B-cell lymphoma (DLBCL) remains unclear. We retrospectively analyzed the survival outcomes and patterns of failure with our institutional experience.
Between 2009 and 2018, 206 patients with stage III-IV DLBCL achieved CR after receiving R-CHOP. Propensity-score matching was used to analyze the role of consolidative RT. The consolidative RT group (n = 34) and the R-CHOP alone group (n = 68) were matched at a 1:2 ratio. After propensity-score matching, 102 patients were analyzed.
With a median follow-up of 39.7 months, 26 patients (25.5%) showed local recurrence. Only one patient failed at the previous RT field. RT was delivered to bulky sites, head and neck lesions, testes, and bone with median dose of 30.6 Gy. The most common site of failure was head and neck lesions followed by bulky sites. The 5-year overall survival (OS), progression-free survival (PFS), and isolated-local recurrence free survival (LRFS) were 73.5, 64.0, and 79.9%. In univariate and multivariate analysis, bone marrow involvement and consolidative RT were associated with isolated LRFS (p = 0.006 and 0.032) significantly.
Consolidative RT improved isolated local control. Based on the pattern of failure, we carefully suggest to radiate on initially involved bulky sites or head and neck lesions. Further studies need to be done to find out the optimal radiation dose and selection of RT site.
在晚期弥漫性大B细胞淋巴瘤（DLBCL）中，利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗后完全缓解（CR）后巩固性放疗（RT）的作用仍不明确。我们根据机构经验回顾性分析了生存结果和失败模式。
2009年至2018年期间，206例III-IV期DLBCL患者在接受R-CHOP治疗后达到CR。采用倾向评分匹配法分析巩固性放疗的作用。巩固性放疗组（n = 34）和单纯R-CHOP组（n = 68）按1:2的比例进行匹配。倾向评分匹配后，对102例患者进行分析。
中位随访39.7个月，26例患者（25.5%）出现局部复发。仅1例患者在先前放疗区域失败。放疗针对大块病灶、头颈部病变、睾丸和骨骼，中位剂量为30.6 Gy。最常见的失败部位是头颈部病变，其次是大块病灶。5年总生存率（OS）、无进展生存率（PFS）和孤立局部复发无病生存率（LRFS）分别为73.5%、64.0%和79.9%。在单因素和多因素分析中，骨髓受累和巩固性放疗与孤立LRFS显著相关（p = 0.006和0.
