Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy.
Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy.
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DOI：
10.1200/jco.2009.27.3441
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发表时间：
2010-09-20
期刊：
影响因子：
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通讯作者：
Dabaja, Bouthaina Shbib
中科院分区：
文献类型：
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作者：
Phan, Jack;Mazloom, Ali;Dabaja, Bouthaina Shbib
目得：目前弥漫性大B细胞淋巴瘤（DLBCL）患者的标准治疗是利妥昔单抗加环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）。巩固放射治疗（RT）在R-CHOP化疗中的作用还没有很好的报道。这种回顾性分析是一种尝试，以澄清这个角色。患者和方法：受试者是469例组织学确诊的DLBCL治疗2001年1月至2007年12月。变量包括年龄、性别、安阿伯疾病分期、巨大病变状态、正电子发射断层扫描（PET）标准化摄取值（SUV）、国际预后指数（IPI）和Ki 67染色结果：在469名患者中，（40.5%）为I期或II期疾病，（59.5%）为III或IV期疾病，327例（70%）至少接受了6个周期的R-CHOP治疗，142例（30.2%）在化疗完全缓解后接受了累及野RT（剂量30 ~ 39.6戈伊）。中位随访时间为36个月（范围：8 - 85个月）。多因素分析显示RT（P < .0001），IPI评分（P = .001），对治疗的反应（P = .001），使用6 - 8个周期的R-CHOP（P <0.001），同时存在高Ki 67、高PET SUV和巨大病变的存在（P = 0.006）或不存在（P = 0.025）影响总生存期（OS）和无进展生存期（PFS）。对接受6 - 8个周期R-CHOP治疗的I期或II期疾病患者进行的配对分析（44对）和所有阶段（74对）表明RT改善了OS（风险比[HR]分别为0.52和0.29）和PFS（HR分别为0.45和0.24）。结论：这项研究显示，在DLBCL患者接受R-CHOP化疗后接受巩固RT的患者中，OS和PFS显著改善。
PURPOSE: The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The role of consolidative radiation therapy (RT) in the setting of R-CHOP chemotherapy is not well reported. This retrospective analysis is an attempt to clarify this role.PATIENTS AND METHODS: Subjects were 469 patients with histologically confirmed DLBCL treated between January 2001 and December 2007. Variables including age, sex, Ann Arbor disease stage, bulky disease status, standardized uptake values (SUVs) on positron emission tomography (PET), International Prognostic Index (IPI), and Ki67 staining (proliferation).RESULTS: Of 469 patients, 190 (40.5%) had stage I or II disease and 279 (59.5%) had stage III or IV disease, 327 (70%) had at least six cycles of R-CHOP, and 142 (30.2%) had involved-field RT (dose, 30 to 39.6 Gy) after complete response to chemotherapy. Median follow-up was 36 months (range, 8 to 85 months). Multivariate analysis showed that RT (P < .0001), IPI score (P = .001), response to therapy (P = .001), use of six to eight cycles of R-CHOP (P < .001), and combined presence (P = .006) or absence (P = .025) of high Ki67, high PET SUV, and bulky disease influenced overall survival (OS) and progression-free survival (PFS). Matched-pair analyses of patients who received six to eight cycles of R-CHOP with stage I or II disease (44 pairs) and all stages (74 pairs) indicated that RT improved OS (hazard ratio [HR], 0.52 and 0.29, respectively) and PFS (HR, 0.45 and 0.24, respectively) compared with no RT.CONCLUSION: This study showed significant improvements in OS and PFS among patients who received consolidation RT after R-CHOP chemotherapy for DLBCL.