Role of radiation therapy in primary tonsil large B cell lymphoma: a SEER-based analysis

Abstract

Backgroud Primary tonsil diffuse large B cell lymphoma (PT-DLBCL) is an uncommon disease entity. The role of radiation therapy (RT) in PT-DLBCL is debatable in both the pre- and post- rituximab era. The purpose of this study was to evaluate the treatment outcome and establish a prognostic model in PT-DLBCL based on the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods Data of 1214 PT-DLBCL patients diagnosed between 1975 and 2016 were extracted from SEER 18. The effect of RT was assessed for the entire cohort and subgroups by stages using univariate, multivariate Cox regression analyses and propensity score matching (PSM). Results The entire cohort included 1043 patients with early-stage (ES) PT-DLBCL and 171 patients with advanced-stage (AS) disease. A decreasing trend of RT utilization in the ES cohort after 2002 was observed. 47.4% of patients in ES received RT, whereas 25.1% in AS underwent RT. RT significantly improved overall survival in both univariate (P < 0.001) and multivariate (P = 0.002) analyses. PSM analysis further validated the survival advantage of RT (P = 0.002). A nomogram was established to predict the potential survival benefit. Subgroup analysis revealed RT was significantly associated with overall survival in ES patients of PT-DLBCL (P = 0.001) and in the rituximab era (P = 0.001) but not in those with AS disease (P = 0.241). Conclusions This population-based study encloses the largest sample of PT-DLBCL to date and demonstrates a favorable survival role of RT in early stages rather than advanced stages. The established nomogram helps to identify high risk patients to improve prognosis.

A new prognostic nomogram in patients with mucosa-associated lymphoid tissue lymphoma: a multicenter retrospective study

“…The recurrence rate of MALT lymphoma during the early stage is lower than during the late stage, which has been confirmed in our study. Different treatments have different prognoses, so some studies have incorporated the treatment model of patients into the prognostic model ( 29 – 33 ). Our study also found that radiotherapy was an independent factor affecting the PFS in MALT lymphoma.…”

Diffuse large B‐cell lymphoma of the Waldeyer's ring: A U.S. population‐based survival analysis

“…Our study includes only stage I DLBCL with primary location in the WR, which assures that the analyzed cases genuinely represent the "primary" DLBCL of the WR, allowing an accurate description of the natural history and treatment modalities for this location. This definition differs from previous studies that included stages I to IV as primary tonsil or WR DLBCL, 4,5 which cannot determine whether tonsil or WR is the primary or secondary location.…”

“…1 Prior studies in stage I to IV DLBCL with involvement of the tonsils reported better survival outcomes incorporating consolidation radiotherapy. 4,5 However, no studies explored treatment strategies in stage I WR DLBCL. Moreover, Lamy et al demonstrated no benefit of consolidation in patients with localized (stage I-II) DLBCL and lowrisk features.…”

“…2 Diffuse large B-cell lymphoma (DLBCL) accounts for 66.5% of NHL cases in the palatine tonsils 3 where only 35% are diagnosed at stage I. 4 Current guidelines in patients with localized WR DLBCL support consolidation with radiotherapy after obtaining a complete response to chemotherapy. 1 Prior studies in stage I to IV DLBCL with involvement of the tonsils reported better survival outcomes incorporating consolidation radiotherapy.…”

Prognostic visualization model for primary pulmonary sarcoma: a SEER-based study

“…Therefore, PPS is very rare and most of the published literature on PPS is case reports, with very few large studies on PPS and its prognosis is extremely poor. Nomogram has simplicity and accuracy and has recently been widely used in the assessment of malignancy prognosis [9,10]. In this study, we explored the clinical characteristics and prognostic factors of PPS and constructed a novel predictive nomogram to predict the OS rate of PPS to enrich the data related to PPS and help clinical decision-making.…”