Xu Yi, Campbell Belinda A, Chan Matthew, Chan Jessica, Farinha Pedro, Venner Christopher P, Scott David W, Gerrie Alina S, Villa Diego, Sehn Laurie H, Savage Kerry J, Lo Andrea C
Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
Department of Radiation Oncology, Peter MacCallum Cancer Center, 305 Grattan Street, Melbourne, Victoria 3000, Australia.
Clin Transl Radiat Oncol. 2024 Sep 29;49:100869. doi: 10.1016/j.ctro.2024.100869. eCollection 2024 Nov.
The optimal management of stage II follicular lymphoma (FL) is unclear. Radiation therapy (RT) alone has been the gold standard treatment, but a proportion of patients relapse. We sought to characterize outcomes and prognostic factors for stage II FL treated with RT alone to identify a high-risk subgroup of patients who may benefit from treatment intensification.
This was a population-based, province-wide, retrospective study. Included patients had grade 1-3A, non-mesenteric, stage IIA or IIAE FL diagnosed between 1986 and 2016 and treated with curative-intent (≥20 Gy) RT alone.
102 patients were included. Median follow-up was 10.4 years (range, 0.3-22.3). Median age was 59 years (range, 33-86). Median greatest disease diameter was 3.6 cm (range, 1.5-11.5). Freedom from progression (FFP) was 60.3% at 5 years and 40.7% at 10 years. Overall survival (OS) was 89.2% at 5 years and 81.8% at 10 years. Greatest disease diameter of >3.6 cm was associated with inferior FFP (10-year FFP 34% vs. 47%, = 0.013) on univariable analysis and inferior FFP (hazard ratio [HR] 1.87, = 0.019) and inferior OS (HR 2.12, = 0.027) on multivariable analysis (MVA). Older age was associated with inferior OS (HR 1.08, unit = 1 year, < 0.001) on MVA.
40.7% of stage II FL patients treated with RT alone remained disease-free at 10 years. Greatest disease diameter >3.6 cm was associated with inferior FFP and OS, representing a novel prognostic indicator in this population that may help in the decision-making process on whether to complement RT with systemic therapy.
II期滤泡性淋巴瘤（FL）的最佳治疗方案尚不清楚。单纯放射治疗（RT）一直是金标准治疗方法，但仍有一部分患者会复发。我们试图描述单纯RT治疗II期FL的疗效和预后因素，以确定可能从强化治疗中获益的高危患者亚组。
这是一项基于人群的全省回顾性研究。纳入的患者为1986年至2016年间诊断为1-3A级、非肠系膜、IIA期或IIAE期FL且接受了根治性意图（≥20 Gy）单纯RT治疗的患者。
共纳入102例患者。中位随访时间为10.4年（范围0.3 - 22.3年）。中位年龄为59岁（范围33 - 86岁）。最大病灶直径中位数为3.6 cm（范围1.5 - 11.5 cm）。5年无进展生存率（FFP）为60.3%，10年为40.7%。5年总生存率（OS）为89.2%，10年为81.8%。单因素分析显示，最大病灶直径>3.6 cm与较差的FFP相关（10年FFP为34%对47%，P = 0.013），多因素分析（MVA）显示较差的FFP（风险比[HR] 1.87，P = 0.019）和较差的OS（HR 2.12，P = 0.027）。多因素分析显示，年龄较大与较差的OS相关（HR 1.08，单位 = 1岁，P < 0.001）。
单纯RT治疗的II期FL患者中，40.7%在10年时仍无疾病。最大病灶直径>3.6 cm与较差的FFP和OS相关，这是该人群中一个新的预后指标，可能有助于决定是否用全身治疗补充RT治疗。
