The role of radiotherapy as salvage and/or consolidation treatment in relapsed/refractory and high‐risk diffuse large B‐cell lymphoma

Abstract

Due to its low toxicity and ease of use, radiotherapy should therefore remain an available option in patients with R/R DLBCL or as consolidation therapy in patients with high-risk disease, mostly in patients with chemo-sensitive disease or bulky disease.

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

“…The toxicities of RT depend especially on the location of involved lymph nodes or tissue [13]. Most toxicities, such as epithelitis, mucositis, diarrhea and dysphagia, were mild and tolerable, and RT-induced interstitial pneumonitis did not lead to the long-term dysfunction of the respiratory system or requirement of assisted ventilation [18]. One two-institutional study assessed the adverse effects of radiotherapy according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 4.0) [2].…”

“…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].…”

“…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]. 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].…”

Impact of Double- or Triple-Hit Pathology on Rates and Durability of Radiation Therapy Response Among Patients With Relapsed or Refractory Large B-Cell Lymphoma

“…4,5 Radiation therapy (RT) represents another treatment option for patients with R/R LBCL, either as consolidation, salvage, or palliation. 6,7 LBCL represents a heterogeneous disease entity 8,9 in which patients with translocation of c-MYC, with translocation of BCL2 or BCL6, have inferior prognosis and present with higher risk disease. [10][11][12] The updated WHO 2016 classification has recognized these pathologic and clinical findings in their designation of high-grade B-cell lymphoma with rearrangements of c-MYC, with BCL2 or BCL6, also referred to colloquially as double/triple hit lymphomas (DHL/THL).…”

“…Retrospective data suggest lower rates of local control with RT among patients with chemoresistant lymphoma. 7,[19][20][21][22][23] We hypothesize that given high rates of chemoresistance associated with DHL/THL, rates and durability of RT response would be lower among R/R patients with DHL/THL compared with non-DHL/THL. Better characterizing the efficacy of RT among R/R DHL/THL patients may help inform whether RT treatment should be intensified, as in the case with chemotherapy.…”