Renewed interest in the role of consolidative radiotherapy in advanced stage diffuse large B-cell lymphoma

Shi, Zhicai; Esiashvili, Natia; Flowers, Christopher R.; Das, Satya

doi:10.3109/10428194.2013.779687

Cited by 14 publications

(14 citation statements)

References 41 publications

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“…The ongoing Unfavorable Low-Risk Patients Treated with Densification of R-Chemo Regimens (UNFOLDER) trial (clinical trial registry: NCT00278408) featuring a 2x2 randomization comparing R-CHOP -21 and 14 as well as RT or no RT to ≥7.5 cm bulky disease will eventually help guide decisions on RT. The arms without RT were recently closed on interim analysis suggesting some benefit to RT[26]. Results from this study will further shed light on management of DLBCL patients.…”

Section: Resultsmentioning

confidence: 99%

Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

Jegadeesh

Rajpara

Esiashvili

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose The role of consolidative radiotherapy (RT) for stage III and IV DLBCL in the era of rituximab is not well defined. There is evidence that some patients with bulky disease may benefit, but patient selection criteria are not well established. We sought to identify a subset of patients who experienced a high local failure rate after receiving rituximab-based chemotherapy alone and hence may benefit from the addition of consolidative RT. Methods and Materials 211 stage III and IV DLBCL patients treated between August 1999 and January 2012 were reviewed. Of these, 89 had a complete response to systemic therapy including rituximab and received no initial RT. Kaplan-Meier analysis and Cox proportional hazards regression were performed with local recurrence (LR) as the primary outcome. Results Median follow-up was 43.9 months. 50% experienced LR at 5 years. In multivariate analysis tumor ≥ 5 cm and stage III disease were associated with increased risk of LR. Five year LR free survival for patients with ≥ 5 cm lesions were 47.4% versus 74.7% for patients with < 5cm lesions (p = 0.01). In patients with < 5 cm tumors, SUVmax was ≥15 in all patients with LR. Five year LR free survival was 100% in SUV < 15 versus 68.8% in SUV≥15 (p=0.10). Conclusions Advanced stage DLBCL patients who are stage III or with disease ≥ 5 cm appear to be at an increased risk for LR. Patients with < 5 cm disease and SUVmax≥15 may be at higher risk for LR. These patients may benefit from consolidative RT following chemoimmunotherapy.

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Section: Resultsmentioning

confidence: 99%

Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

Jegadeesh

Rajpara

Esiashvili

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…It compares 2 schedules of RCHOP (RCHOP-21 or -14) with or without consolidative RT in aggressive B-cell NHL patients [28]. Relatively young patients (aged 18-60 years), initially with bulky disease (≥7.5 cm) and/or qualifying extranodal involvement, who achieved CR to 6 cycles of RCHOP-14 or -21 will be further randomized to observation versus consolidative RT.…”

Section: Discussionmentioning

confidence: 99%

The Role of Consolidative Radiotherapy after a Complete Response to Chemotherapy in the Treatment of Diffuse Large B-Cell Lymphoma in the Rituximab Era: Results from a Systematic Review with a Meta-Analysis

Hu¹,

Deng²,

Zou³

et al. 2015

Acta Haematol

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Background: The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP). The role of radiotherapy (RT) after complete response (CR) to RCHOP in patients with DLBCL remains unclear. This systematic review with a meta-analysis is an attempt to evaluate this role. Methods: Studies that evaluated RT versus no-RT after CR to RCHOP for DLBCL patients were searched in databases. Hazard ratios (HR) with their respective 95% confidence intervals (CI) were calculated using a random-effects model. Results: A total of 4 qualified retrospective studies (633 patients) were included in this review. The results suggested that RT improved overall survival (OS; HR 0.33, 95% CI 0.14-0.77) and progression-free/event-free survival (PFS/EFS; HR 0.24, 95% CI 0.11-0.50) in all patients compared with no-RT. In a subgroup analysis of patients with stage III-IV DLBCL, RT improved PFS/EFS (HR 0.19, 95% CI 0.07-0.51) and local control (HR 0.12, 95% CI 0.03-0.44), with a trend of improving OS (HR 0.35, 95% CI 0.12-1.05). Conclusion: Consolidation RT could significantly improve outcomes of DLBCL patients who achieved a CR to RCHOP. However, the significance of these results was limited by these retrospective data. Further investigation of the role of consolidation RT in the rituximab era is needed.

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“…[4–7] In summary, these trials suggested that combined modality treatment with RT and lesser courses of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) was at least as efficacious as full course of chemotherapy. [8] GELA 93-4 looked specifically at older patients and found that RT with CHOP had similar survival rates as CHOP alone [4] and suggested that RT for elderly patients can be omitted all together.…”

Section: Introductionmentioning

confidence: 99%

The role of radiotherapy for patients over age 60 with diffuse large B-cell lymphoma in the rituximab era

Cassidy

Jegadeesh

Switchenko

et al. 2016

Leukemia & Lymphoma

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The role of consolidative radiotherapy (RT) in patients ≥60 years old with DLBCL in the rituximab era is controversial. We examined the impact on disease control and overall survival by the addition of consolidative RT after completion of chemotherapy, while adjusting for known adverse risk factors. Retrospective chart review from 2004 to 2012 of 83 consecutive patients ≥60 years old with DLBCL treated in the rituximab era, 68 of which had a complete response to chemotherapy, was performed. Amongst patients with a complete response, consolidative RT use was associated with 100% 5-year local control, improved progression-free survival (p = 0.047), and a trend for overall survival (p = .098) on multivariate analysis. Amongst all patients, the use of consolidative RT was associated with improved overall survival (p = 0.03). The use of consolidative RT should be considered for patients ≥60 years old independent of stage and response to chemotherapy.

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Renewed interest in the role of consolidative radiotherapy in advanced stage diffuse large B-cell lymphoma

Cited by 14 publications

References 41 publications

Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

The Role of Consolidative Radiotherapy after a Complete Response to Chemotherapy in the Treatment of Diffuse Large B-Cell Lymphoma in the Rituximab Era: Results from a Systematic Review with a Meta-Analysis

The role of radiotherapy for patients over age 60 with diffuse large B-cell lymphoma in the rituximab era

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