Dosimetric and Clinical Outcomes With Intensity Modulated Radiation Therapy After Chemotherapy for Patients With Early-Stage Diffuse Large B-cell Lymphoma of Waldeyer Ring

Xu, Yan; Qi, Shunan; Wang, Shulian; Liu, Yueping; Wang, Weihu; Jin, Jing; Song, Yongwen; Ren, Hua; Fang, Hui; He, Xiaohong; Dong, Mei; Chen, Bin; Liu, Ningning; Li, Ning; Tang, Yuan; Dai, Jianrong; Li, Yexiong

doi:10.1016/j.ijrobp.2016.05.023

Cited by 7 publications

(5 citation statements)

References 49 publications

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“…WR-DLBCL is more common in China compared to Western countries and is characterized by early stages, low IPI scores, and a favorable prognosis. [ 2 , 7 ] Of the 84 cases with WR-DLBCL in our study, the low-risk of IPI ≤2 had a proportion of 78.6% ( n = 66), 76.2% of cases (64/84 were localized diseases), and patients with stage II of the disease accounted for the highest proportion of the whole (58.3%). Furthermore, the OS rates at the 2-year and 5-year of all patients were 92.8% and 80.9%, respectively, which were consistent with the results of previous studies.…”

Section: Discussionmentioning

confidence: 81%

“…[ 5 ] Moreover, some studies have shown that consolidation RT in the WR region after R-CHOP therapy may lead to RT-associated toxicity such as dysgeusia, xerostomia, tooth loss, and secondary malignancies, affecting the patient's short-term and long-term quality of life. [ 6 , 7 ] Hence, treatment strategies to mitigate unnecessary exposure to RT should be considered in patients with WR-DLBCL. Furthermore, one-third of cases are resistant to R-CHOP therapy, suggesting the limited efficacy of this regimen in WR-DLBCL.…”

Section: Introductionmentioning

confidence: 99%

“…In the era of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy, it has significantly improved clinical response and long-term survival of patients, while the clinical benefits of adding radiation therapy have decreased [5] . Moreover, some studies have shown that consolidation RT in the WR region after R-CHOP therapy may lead to RT-associated toxicity such as dysgeusia, xerostomia, tooth loss, and secondary malignancies, affecting the patient's short-term and long-term quality of life [6,7] . Hence, treatment strategies to mitigate unnecessary exposure to RT should be considered in patients with WR-DLBCL.…”

Section: Introductionmentioning

confidence: 99%

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Dose-adjusted EPOCH-R vs. R-CHOP in frontline management of Waldeyer's ring diffuse large B-cell lymphoma: a retrospective study from a single institution

Liang

Liu

Yang

et al. 2023

Chinese Medical Journal

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Background:To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution.Methods:This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS).Results:During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan–Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4–99.8%) and 95.2% (95% CI: 89.0–100.0%), respectively, and 80.5% (95% CI: 69.3–93.6%) and 90.5% (95% CI: 52.8–99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01–0.88) and 0.042 (HR: 0.19; 95% CI: 0.04–0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups.Conclusion:Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dose-adjusted EPOCH-R vs. R-CHOP in frontline management of Waldeyer's ring diffuse large B-cell lymphoma: a retrospective study from a single institution

Liang

Liu

Yang

et al. 2023

Chinese Medical Journal

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“…The standard treatment of Waldeyer’s ring DLBCL with limited stage remains controversial. Consolidation radiotherapy may prolong survival but can cause many acute or chronic toxicities, such as acute oral mucositis, dental decay, and xerostomia [ 25 , 26 ]. In the same decade, Li et al [ 18 ] conducted a retrospective study to evaluate the role of consolidation radiotherapy in patients with stage I/II DLBCL limited to Waldeyer’s ring in our centre.…”

Section: Discussionmentioning

confidence: 99%

Four cycles of R-CHOP followed by two applications of rituximab based on negative interim PET/CT: an analysis of a prospective trial

Jin

Xia

et al. 2022

BMC Cancer

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Background R-CHOP with or without radiotherapy is the standard treatment for limited-stage diffuse large B-cell lymphoma (DLBCL). To prevent overtreatment, we assessed whether four cycles of CHOP plus six applications of rituximab was adequate with negative interim PET/CT and the role of consolidation radiotherapy specifically for patients with Waldeyer’s ring DLBCL. One hundred and twenty-nine patients with limited-stage DLBCL were enrolled in this open-label, nonrandomized, single-arm, phase 2 clinical trial (NCT01804127). Methods All patients were initially treated with 4 cycles of R-CHOP and underwent interim PET/CT. Patients with negative PET/CT (Deauville scores 1–2) received 2 additional cycles of rituximab monotherapy, unless they had any risk factors (primary mediastinal large B-cell lymphoma, extranodal primary or bulky disease). Otherwise, patients received another 2 cycles of R-CHOP. Patients with partial response on interim PET/CT received another 4 cycles of R-CHOP. No radiotherapy was conducted in Waldeyer’s ring DLBCL patients with negative PET/CT. The primary endpoint was 3-year progression-free survival (PFS). Overall survival (OS) in this study was compared with those from a historical study (NCT 00854568159). Results One hundred fifteen interim PET/CT scans (89.1%) were negative after 4 cycles of R-CHOP. An elevated lactate dehydrogenase level was significantly associated with positive interim PET/CT (P < 0.05). A trend of inferior outcome was observed in patients with positive interim PET/CT in terms of 3-year PFS (78.6% vs. 91.9%, P = 0.24) and 3-year OS (85.7% vs. 95.6%, P = 0.16). There were no PFS or OS differences found between patients treated with 4R-CHOP+2R and those treated with 6R-CHOP from a historical control study. Patients with Waldeyer’s ring DLBCL and negative interim PET/CT achieved a 3-year PFS of 87.2% and a 3-year OS of 89.7%. Conclusions Our results suggested that for interim PET/CT-negative patients without risk factors, the extra 2 cycles of CHOP might be omitted, and radiotherapy might also be omitted in patients with Waldeyer’s ring DLBCL without compromising the efficacy. These results need to be confirmed in a randomized study. Trial registration clinicaltrials.gov, NCT 01804127. Date of first registration: 05/03/2013.

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“…Non-Hodgkin's lymphoma (NHL) comprises a clinically and pathologically heterogeneous group of disorders originating from lymphoid tissue, and the majority of all NHLs arise from B lymphocytes (B-NHL) (1). Waldeyer's ring is defined as a circular band of extranodal lymphoid tissues consisting of palatine tonsils, soft palate, nasopharynx, base of tongue, and oropharyngeal wall, which is the most common site of B-NHL in head and neck area (2)(3)(4). Due to the specific location of lesion, chemotherapy combination with radiation therapy (RT) is currently applied for the primary treatment in B-NHL of Waldeyer's ring (WR-B-NHL) (5,6).…”

Section: Introductionmentioning

confidence: 99%

Systemic immune response associated with radiation therapy in B‑cell non‑Hodgkin's lymphoma of Waldeyer's ring

Niu

et al. 2018

Oncol Rep

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Radiation therapy (RT) is one of the most effective therapeutic modalities for B-cell non-Hodgkin's lymphoma of Waldeyer's ring (WR-B-NHL). However, the responsiveness of RT remains controversial and clinical biomarkers are required to predict survival in RT-treated patients with WR-B-NHL. Previous studies have suggested an association between RT and systemic immune responses. In the present retrospective study, the lymphocyte to monocyte ratio (LMR) was identified as a systemic immune indicator in RT-treated patients with WR-B-NHL, and the prognostic value of the LMR with RT and systemic immune responses were evaluated. The optimal cutoff value of the LMR was selected as 3.14, and a high LMR demonstrated improved prognosis and was considered an independent prognostic indicator in RT-treated patients, particularly in patients with distant non-irradiated lesions. Furthermore, reverse transcription-quantitative polymerase chain reaction and ELISA analysis of irradiated lymphoma cell lines and serum samples from patients with WR-B-NHL demonstrated the upregulated expression levels of 4-1BB ligands, calreticulin and high mobility group box 1 compared with non-irradiated groups. Additionally, CD8 + T cells and expression levels of interferon-γ in T cells co-cultured with irradiated cells were significantly increased compared with non-irradiated cells. The results indicated that the anti-programmed cell death protein 1 (PD-1) antibody may serve a role in lymphoma therapy when combined with RT. The results of the present study demonstrated the prognostic significance of the LMR associated with RT in patients with WR-B-NHL and acknowledged the potential use of PD-1 antibody in RT-treated lymphomas.

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Dosimetric and Clinical Outcomes With Intensity Modulated Radiation Therapy After Chemotherapy for Patients With Early-Stage Diffuse Large B-cell Lymphoma of Waldeyer Ring

Cited by 7 publications

References 49 publications

Dose-adjusted EPOCH-R vs. R-CHOP in frontline management of Waldeyer's ring diffuse large B-cell lymphoma: a retrospective study from a single institution

Dose-adjusted EPOCH-R vs. R-CHOP in frontline management of Waldeyer's ring diffuse large B-cell lymphoma: a retrospective study from a single institution

Four cycles of R-CHOP followed by two applications of rituximab based on negative interim PET/CT: an analysis of a prospective trial

Systemic immune response associated with radiation therapy in B‑cell non‑Hodgkin's lymphoma of Waldeyer's ring

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