Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
Department of Radiation Oncology, Stanford Cancer Center, Palo Alto, California.
Int J Radiat Oncol Biol Phys. 2021 Sep 1;111(1):36-44. doi: 10.1016/j.ijrobp.2021.03.035. Epub 2021 Mar 24.
Primary mediastinal B cell lymphoma (PMBCL) is a highly curable subtype of non-Hodgkin lymphoma that is diagnosed predominantly in adolescents and young adults. Consequently, long-term treatment-related morbidity is critical to consider when devising treatment strategies that include different chemoimmunotherapy strategies with or without radiation therapy. Furthermore, adaptive approaches using the end-of-chemotherapy (EOC) positron emission tomography (PET)/computed tomography (CT) scanning may help to determine which patients may benefit from additional therapies. We aimed to develop evidence-based guidelines for treating these patients.
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database. The ARS expert committee, composed of radiation oncologists, hematologists, and pediatric oncologists, developed consensus guidelines using the modified Delphi framework.
Nine studies met the full criteria for inclusion based on reporting outcomes on patients with primary mediastinal B cell lymphoma with EOC PET/CT response scored with the 5-point Deauville scale. These studies formed the evidence for these guidelines in managing patients with PMBCL according to the EOC PET response, including after a 5-point Deauville scale of 1 to 3, 4, or 5, and for patients with relapsed and refractory disease. The expert group also developed guidance on radiation simulation, treatment planning, and plan evaluation based on expert opinion.
Various treatment approaches exist in the management of PMBCL, including different chemoimmunotherapy regimens, the use of consolidative radiation therapy, and adaptive approaches based on EOC PET/CT response. These guidelines can be used by practitioners to provide appropriate treatment according to different disease scenarios.
原发性纵隔 B 细胞淋巴瘤（PMBCL）是一种高度可治愈的非霍奇金淋巴瘤亚型，主要在青少年和年轻成人中诊断。因此，在制定包括不同化疗免疫治疗策略以及是否联合放疗的治疗策略时，必须考虑长期治疗相关的发病率。此外，使用化疗结束时（EOC）正电子发射断层扫描（PET）/计算机断层扫描（CT）扫描的适应性方法可能有助于确定哪些患者可能受益于额外的治疗。我们旨在为这些患者制定循证治疗指南。
我们根据系统评价和荟萃分析的首选报告项目，使用 PubMed 数据库进行了系统评价。由放射肿瘤学家、血液学家和儿科肿瘤学家组成的 ARS 专家委员会使用改良 Delphi 框架制定了共识指南。
根据 9 项研究的报告结果，这些研究符合纳入标准，这些研究的纳入标准是报告了 EOC PET/CT 反应的原发性纵隔 B 细胞淋巴瘤患者，EOC PET/CT 反应采用 5 分 Deauville 评分进行评分。这些研究为根据 EOC PET 反应管理 PMBCL 患者提供了循证指南，包括 5 分 Deauville 评分 1 至 3、4 或 5 分的患者，以及复发和难治性疾病的患者。专家组还根据专家意见制定了关于放射模拟、治疗计划和计划评估的指南。
PMBCL 的管理存在多种治疗方法，包括不同的化疗免疫治疗方案、使用巩固性放疗以及基于 EOC PET/CT 反应的适应性方法。这些指南可由从业者根据不同的疾病情况使用，为患者提供适当的治疗。
