Liang Xiping, Deng Xu, Xie Kanglin, Wang Chaoyu, Liu Yao
Department of Hematology-Oncology Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China.
Chongqing Medical University, Chongqing, China.
J Cell Mol Med. 2025 Sep;29(18):e70822. doi: 10.1111/jcmm.70822.
Rituximab has improved response rates and overall survival in diffuse large B-cell lymphoma (DLBCL). Radiotherapy (RT) is an effective treatment modality for lymphomas. However, significant conceptual challenges, including the application in elderly patients, varying IPI scores and CR patients, remain regarding the current use of RT. We performed a systematic review comparing chemotherapy with RT to chemotherapy alone in patients with DLBCL. We estimated hazard ratios (HR) for OS, PFS and EFS using the proportional hazards model. Five articles involving 1364 patients met inclusion criteria. Patients undergoing consolidative RT had better OS (HR = 0.46, 95% CI 0.31-0.68), PFS (HR = 0.52, 95% CI 0.22-1.25) and EFS (HR = 0.42, 95% CI 0.20-0.90) compared to those who received no RT. But no benefit was shown in patients with achievement of CR. The protective effect of consolidation RT for patients with advanced IPI scores (HR = 0.46, 95% CI 0.31-0.68) and advanced stage (HR = 0.22, 95% CI 0.08-0.59) was shown. The consolidation RT showed a significantly longer PFS (HR = 0.50, 95% CI 0.26-0.94) but no significant benefit on OS in patients with bulky disease. There was also significantly better PFS in RT patients (HR = 0.67, 95% CI 0.49-0.92), but no significant benefit on OS in old age patients. RT act as an efficacious method for DLBCL following a full course of chemotherapy. However, no OS benefit was shown in patients with advanced IPI scores, bulky disease, CR and old age.
利妥昔单抗已提高了弥漫性大B细胞淋巴瘤（DLBCL）的缓解率和总生存率。放射治疗（RT）是淋巴瘤的一种有效治疗方式。然而，关于RT的当前应用仍存在重大概念性挑战，包括在老年患者中的应用、不同的国际预后指数（IPI）评分以及完全缓解（CR）患者。我们进行了一项系统评价，比较DLBCL患者接受化疗联合RT与单纯化疗的效果。我们使用比例风险模型估计总生存期（OS）、无进展生存期（PFS）和无事件生存期（EFS）的风险比（HR）。五篇涉及1364例患者的文章符合纳入标准。与未接受RT的患者相比，接受巩固性RT的患者具有更好的OS（HR = 0.46，95%可信区间[CI] 0.31 - 0.68）、PFS（HR = 0.52，95% CI 0.22 - 1.25）和EFS（HR = 0.42，95% CI 0.20 - 0.90）。但CR患者未显示出获益。巩固性RT对IPI评分高（HR = 0.46，95% CI 0.31 - 0.68）和晚期（HR = 0.22，95% CI 0.08 - 0.59）患者具有保护作用。巩固性RT在有大包块病变的患者中显示出显著更长的PFS（HR = 0.50，95% CI 0.26 - 0.94），但对OS无显著益处。RT患者的PFS也显著更好（HR = 0.67，95% CI 0.49 - 0.92），但老年患者的OS无显著益处。RT作为DLBCL患者全程化疗后的一种有效方法。然而，IPI评分高、有大包块病变、CR和老年患者未显示出OS获益。
