Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging
Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging
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DOI：
10.1016/j.ijrobp.2011.12.067
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发表时间：
2012-11-01
影响因子：
7
通讯作者：
Kelsey, Chris R.
中科院分区：
文献类型：
--
作者：
Dorth, Jennifer A.;Prosnitz, Leonard R.;Kelsey, Chris R.
目的：在巩固放射治疗（即，RT化疗后管理）是常规治疗早期弥漫性大B细胞淋巴瘤（DLBCL）患者，巩固RT在III-IV期DLBCL的作用是有争议的。方法和材料：病例与III-IV期DLBCL治疗1991年至2009年在杜克大学，谁取得了完全缓解化疗。使用Kaplan-Meier方法计算临床结局，并使用对数秩检验比较接受和未接受RT的患者。采用考克斯比例风险模型进行多因素分析。化疗（中位数，6个周期）包括抗CD 20抗体利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP; 65%）;环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP; 22%）;或其他（13%）。化疗后成像包括正电子发射断层扫描（PET）/计算机断层扫描（CT）（73%）;镓与CT（14%）;或仅CT（13%）。对38例（48%）患者的病变部位进行了巩固RT（中位数，25戈伊）。接受巩固RT与改善现场控制相关（分别为92%和69%，p = 0.028）和无事件生存率（分别为85%和65%，p = 0.014），但总生存期无差异（分别为85%和78%，p = 0.15）。在多变量分析中，无RT可预测现场故障风险增加（风险比[HR]，8.01，p = 0.014）和更差的无事件生存期（HR，4.3，p = 0.014）。结论：实现阴性化疗后成像的III-IV期DLBCL患者通过低剂量巩固RT改善了现场控制和无事件生存。
Purpose: While consolidation radiation therapy (i.e., RT administered after chemotherapy) is routine treatment for patients with early-stage diffuse large B-cell lymphoma (DLBCL), the role of consolidation RT in stage III-IV DLBCL is controversial.Methods and Materials: Cases of patients with stage III-IV DLBCL treated from 1991 to 2009 at Duke University, who achieved a complete response to chemotherapy were reviewed. Clinical outcomes were calculated using the Kaplan-Meier method and were compared between patients who did and did not receive RT, using the log-rank test. A multivariate analysis was performed using Cox proportional hazards model.Results: Seventy-nine patients were identified. Chemotherapy (median, 6 cycles) consisted of anti-CD20 antibody rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 65%); cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP; 22%); or other (13%). Post-chemotherapy imaging consisted of positron emission tomography (PET)/computed tomography (CT) (73%); gallium with CT (14%); or CT only (13%). Consolidation RT (median, 25 Gy) was given to involved sites of disease in 38 (48%) patients. Receipt of consolidation RT was associated with improved in-field control (92% vs. 69%, respectively, p = 0.028) and event-free survival (85% vs. 65%, respectively, p = 0.014) but no difference in overall survival (85% vs. 78%, respectively, p = 0.15) when compared to patients who did not receive consolidation RT. On multivariate analysis, no RT was predictive of increased risk of in-field failure (hazard ratio [HR], 8.01, p = 0.014) and worse event-free survival (HR, 4.3, p = 0.014).Conclusions: Patients with stage III-IV DLBCL who achieve negative post-chemotherapy imaging have improved in-field control and event-free survival with low-dose consolidation RT. (C) 2012 Elsevier Inc.