Consolidative Radiotherapy to Residual Masses After Chemotherapy Is Associated With Improved Outcome in Diffuse Large B-Cell Lymphoma. A Retrospective, Population-Based Study

Fluge, Øystein; Mannsåker, Bård; Torp, Anders Herman; Mjaaland, Ingvil; Helgeland, Lars; Kłos, Jan; Mella, Olav; Berentsen, Sigbjørn; Meyer, Peter

doi:10.1016/j.clml.2017.12.002

Cited by 7 publications

(8 citation statements)

References 37 publications

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“…12 In Norway, researchers reported improved outcome among patients with any residual mass and RT vs no RT, but it was not evident in patients who were considered high-risk (IPI 4-5). 25 Recently published results of randomized study found that R-CHOP alone is not inferior compared to R-CHOP + RT among patients with limited-stage disease and without bulky tumor. This study included iPET as an evaluation method for all patients.…”

Section: Discussionmentioning

confidence: 98%

“…According to Pfreundschuh et al, results from OPTIMAL > 60 study, it seems that RT can be spared from patients with bulky but negative iPET after chemotherapy without compromising the results . In Norway, researchers reported improved outcome among patients with any residual mass and RT vs no RT, but it was not evident in patients who were considered high‐risk (IPI 4‐5) . Recently published results of randomized study found that R‐CHOP alone is not inferior compared to R‐CHOP + RT among patients with limited‐stage disease and without bulky tumor.…”

Section: Discussionmentioning

confidence: 99%

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Significance of bulky mass and residual tumor—Treated with or without consolidative radiotherapy—To the risk of relapse in DLBCL patients

et al. 2020

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Bulky and residual tumor are considered to increase the risk of relapse in diffuse large B‐cell lymphoma (DLBCL) patients. Radiotherapy is conventionally used to reduce the risk, but the evidence is controversial. We performed a retrospective analysis to evaluate the significance of bulky and residual tumor treated with or without radiotherapy in DLBCL patients. We analyzed 312 DLBCL patients treated from 2010‐2017 in Oulu University Hospital. A bulky tumor was detected in 123 patients and 55 of these patients (44.3%) received consolidative radiation therapy (RT) to the bulky tumor. Residual tumor meeting the required criteria was found in 138 (39.3%) patients, and 65 (45.5%) of these patients received consolidative RT to the site of residual tumor. iPET‐CT scans were performed in 102 patients. In multivariate analyses, bulky was an independent risk factor in limited stage patients in progression free survival (HR 6.43 [95%CI 1.609‐25.710]; P = .008) not related to International prognostic index (HR 1.35 [95% CI 0.256‐7.124]; P = .724) or age (HR 1.62 [95% CI 0.468‐5.638]; P = .445). This was not seen in advanced stage patients or in patients with residual tumor. Radiotherapy to the bulky or residual tumor was not able to improve the long‐term PFS of patients. In this study, it appears that performing iPET is the most convincing method in improving evaluation and in finding patients with increased risk of relapse. Evidently, patients with negative iPET will not benefit from including RT in the treatment after metabolic complete response (CR), and patients with primary refractory disease are most likely in the group of positive iPET.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Significance of bulky mass and residual tumor—Treated with or without consolidative radiotherapy—To the risk of relapse in DLBCL patients

et al. 2020

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“…40 Previously published retrospective analyses, most performed in the absence of functional imaging for response assessment, have suggested benefit conferred by the use of routine consolidative RT in advanced DLBCL, in addition to its application to certain extranodal sites, in particular skeletal involvement. 9,10,17,18,[41][42][43][44] As a result, there are recommendations that continue to endorse RT in these patients. 7,13,45 We acknowledge that there are centers that have changed their practice in the modern era and have already adopted a similar PET-guided algorithm, omitting RT in patients with PET-NEG scans at EOT.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of PET-guided radiation in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP

Freeman

Savage

Villa

et al. 2021

Blood

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Consolidative radiation therapy (RT) for advanced-stage diffuse large B-cell lymphoma (DLBCL) remains controversial with routine practice continuing to include RT in patients with initial bulky disease or residual masses. PET-CT is a sensitive modality for detecting the presence of residual disease at end-of-treatment (EOT). A PET-guided approach to selectively administer RT has been policy in BC since 2005. Patients with advanced-stage DLBCL diagnosed between January 2005 - March 2017 treated with at least 6 cycles of R-CHOP that underwent EOT-PET were included in this analysis. Those with complete metabolic response (PET-NEG) were observed; those with PET-positive scans (PET-POS) were offered consolidative RT, when feasible. 723 patients were identified with median follow-up of 4.3 years: 517 (72%) were PET-NEG; 206 (28%) were PET-POS. Time-to-progression (TTP) and overall survival (OS) at 3 years were 83% v 56% and 87% v 64%, for PET-NEG and PET-POS patients, respectively. Non-progressing PET-POS patients treated with consolidative RT (109/206, 53%) had outcomes approaching those of PET-NEG patients, with 3-year estimates of 76% and 80% for TTP and OS. PET-NEG patients with bulky disease (≥10 cm) at diagnosis, had outcomes indistinguishable from those without bulk, despite omitting RT. These data suggest that patients with advanced-stage DLBCL that are PET-NEG at EOT and receive no RT have excellent outcomes. FDG-PET can reliably guide selective administration of consolidative RT, even for patients with initially bulky disease.

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“…Although the exact definition of bulky disease is still under debate, ranging between 5 and 10 cm, it has been proven that RT contributes significantly to locoregional control (LRC) and survival for patients with bulky or residual disease after chemotherapy [18,[21][22][23][24]. In multivariate analysis, bulky disease was associated with better PFS and OS (HR=0.02, p=0.009) [18].…”

Section: Bulky or Residual Diseasementioning

confidence: 99%

“…In multivariate analysis, bulky disease was associated with better PFS and OS (HR=0.02, p=0.009) [18]. Øystein Fluge et al analysed 211 DLBCL patients and divided patients into complete remission (CR) group (n=73) and any residual mass group (n=138), which included partial response (PR) and CR unconfirmed (Cru) [23]. Among 138 patients with any residual mass after chemotherapy, 57 patients did not receive RT and 81 patients received RT.…”

Section: Bulky or Residual Diseasementioning

confidence: 99%

The Value of Radiation Therapy for the Treatment of Diffuse Large B-Cell Lymphoma in a New Era

Yuan¹,

Zhang²,

Wu³

et al. 2022

COR

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As a highly heterogeneous disease, diffuse large B-cell lymphoma shows different clinical presentations, molecular and immunophenotypic characteristics, International Prognostic Index (IPI score) and response to therapy, which consequently brings about different prognoses and survival results. In addition to surgery and chemotherapy, radiation is also one important modality to treat diffuse large B-cell lymphoma. Over the past few decades, radiation therapy has stepped forward because of technological revolutions. The role of radiation in treating diffuse large B-cell lymphoma is discussed, including: i) advances in modern-day radiation technology ii) potential toxicity from radiation, iii) indications for radiation, and iv) available studies about the efficacy of radiation.

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Consolidative Radiotherapy to Residual Masses After Chemotherapy Is Associated With Improved Outcome in Diffuse Large B-Cell Lymphoma. A Retrospective, Population-Based Study

Abstract: With the limitations of a retrospective study, these data suggest that consolidative RT might improve survival in DLBCL patients with a residual mass after chemotherapy, also in advanced disease.

Cited by 7 publications

References 37 publications

Significance of bulky mass and residual tumor—Treated with or without consolidative radiotherapy—To the risk of relapse in DLBCL patients

Significance of bulky mass and residual tumor—Treated with or without consolidative radiotherapy—To the risk of relapse in DLBCL patients

Long-term results of PET-guided radiation in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP

The Value of Radiation Therapy for the Treatment of Diffuse Large B-Cell Lymphoma in a New Era

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