Chemotherapy Plus Radiotherapy Versus Chemotherapy Alone for Patients With Peripheral T-Cell Lymphoma, Not Otherwise Specified

Abstract

PurposePeripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is a clinically and biologically heterogeneous disease with poor prognosis. As the role of radiation therapy (RT) is still unclear, we carried out this study to evaluate the potential efficacy of RT in PTCL-NOS.MethodsPatients diagnosed with PTCL-NOS between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching was used to balance the characteristics between patients who received radiotherapy and those who did not receive radiotherapy. In addition, we validated the findings in an external validation cohort retrospectively recruited from two high-capacity cancer center in China between 2006 and 2016. Kaplan-Meier curves and Cox regression models were used for survival analysis.ResultsOf the 2,768 patients with chemotherapy records in the SEER cohort, 27.6% of 844 patients with early-stage disease and 6.8% of 1,924 patients with advanced-stage disease received RT. The application of RT was significantly associated with an improvement in overall survival (5-year OS rate 58.5 versus 35.1%, P <0.001) and disease-specific survival (5-year DSS rate 66.3 versus 44.0%, P <0.001) in the early-stage subgroup, while no apparent survival benefit of adding RT was identified in patients with advanced-stage disease (5-year OS rate 28.7 versus 24.4%, P = 0.089; 5-year DSS rate 32.9 versus 31.3%, P = 0.223). After adjustment, a matched cohort of 1,044 patients (348 in the RT combined with CT group and 696 in the CT alone group) was created. And RT was still significantly associated with a survival benefit in the early-stage subset, but not in the advanced-stage disease group. In the validation cohort with more comprehensive data, RT also significantly improved the survival of early-stage PTCL-NOS patients.ConclusionAdding RT was associated with significant improvement in survival in early-stage PTCL-NOS, but the survival benefit of RT was not obvious in advanced-stage disease. The incorporation of RT for treatment in early-stage PTCL-NOS should be highly considered. Further prospective studies with more comprehensive data are needed to evaluate the effectiveness and toxicity of RT in PTCL-NOS.

Outcome of limited‐stage peripheral T‐Cell lymphoma after CHOP(−like) therapy: A population based study of 239 patients from the Nordic lymphoma epidemiology group

“…Two recent retrospective studies have explored the effects of RTx in limited‐stage PTCLs based on the “SEER” and the North American “National Cancer Database” 24,25 . SEER is an administrative database covering MEDICARE from the year 1975 and onward with limited information on treatments and outcomes.…”

Diagnosis, management and follow up of peripheral T‐cell lymphomas: a consensus practice statement from the Australasian Lymphoma Alliance

“…Although randomised evidence is lacking, retrospective series report clinically significant improvements in disease-specific survival, PFS and OS with consolidative RT in limited stage PTCL-NOS. [39][40][41][42][43] A recently published analysis using the National Cancer Database of 3670 patients with early stage PTCL-NOS and ALK negative ALCL reported an OS benefit favouring the addition of consolidation RT (HR 0.69 (95% confidence interval (CI): 0.58-0.84; P < 0.01) on multivariate analysis. 41 Furthermore, data analysed from the Surveillance, Epidemiology, and End Results (SEER) database revealed an improvement in 5-year OS from 35% to 59% with the addition of RT in patients with Peripheral T-cell lymphomas limited-stage PTCL-NOS (HR 0.527; 95% CI: 0.427-0.651; P < 0.001).…”

“…41 Furthermore, data analysed from the Surveillance, Epidemiology, and End Results (SEER) database revealed an improvement in 5-year OS from 35% to 59% with the addition of RT in patients with Peripheral T-cell lymphomas limited-stage PTCL-NOS (HR 0.527; 95% CI: 0.427-0.651; P < 0.001). 43 There is no evidence for an adapted PETguided approach for the omission of RT in limited stage PTCL.…”

“…Following systemic therapy, consolidation RT is recommended for limited‐stage (stage I/II) PTCL treated with curative intent. Although randomised evidence is lacking, retrospective series report clinically significant improvements in disease‐specific survival, PFS and OS with consolidative RT in limited stage PTCL‐NOS 39–43 . A recently published analysis using the National Cancer Database of 3670 patients with early stage PTCL‐NOS and ALK negative ALCL reported an OS benefit favouring the addition of consolidation RT (HR 0.69 (95% confidence interval (CI): 0.58–0.84; P < 0.01) on multivariate analysis 41 .…”

“…A recently published analysis using the National Cancer Database of 3670 patients with early stage PTCL‐NOS and ALK negative ALCL reported an OS benefit favouring the addition of consolidation RT (HR 0.69 (95% confidence interval (CI): 0.58–0.84; P < 0.01) on multivariate analysis 41 . Furthermore, data analysed from the Surveillance, Epidemiology, and End Results (SEER) database revealed an improvement in 5‐year OS from 35% to 59% with the addition of RT in patients with limited‐stage PTCL‐NOS (HR 0.527; 95% CI: 0.427–0.651; P < 0.001) 43 . There is no evidence for an adapted PET‐guided approach for the omission of RT in limited stage PTCL.…”