BACKGROUND: For limited-stage diffuse large B-cell lymphoma (DLBCL), treatment decisions are often influenced by toxicity profiles. One strategy that minimizes chemotherapy-induced toxicities is abbreviated chemotherapy plus consolidation involved-field radiotherapy (IFRT). Involved-node radiotherapy (INRT) is a new concept to DLBCL, aimed to reduce radiotherapy-induced toxicities. We retrospectively review the long-term outcomes of limited-stage DLBCL treated with abbreviated systemic therapy and radiotherapy focusing on field size: IFRT versus INRT. METHODS: The British Columbia Cancer Agency Lymphoid Cancer Database was used to identify patients diagnosed with limited-stage DLBCL (stage I/II, without B-symptoms; bulk < 10 cm) from 1981 to 2007. Patients were prescribed 3 cycles of chemotherapy plus IFRT (1981-1996) or INRT≤5 cm (1996-2007), defined as INRT to the prechemotherapy involved nodes with margins ≤ 5 cm. RESULTS: A total of 288 patients were identified: 56% were aged >60 years, 34% had stage II disease, 55% had extranodal disease, 19% had elevated lactate dehydrogenase levels, and 15% received rituximab. The two radiotherapy groups were IFRT (138 patients; 48%) and INRT≤5cm (150 patients; 52%); median follow-up was 117 and 89 months, respectively. Distant relapse was the most common site of failure in both groups. After INRT≤5 cm, marginal recurrence was infrequent (2%). Time to progression (P = .823), progression-free survival (P = .575), and overall survival (P = .417) were not significantly different between the radiotherapy cohorts. Radiotherapy field size was not a significant prognostic factor on multivariate analyses. CONCLUSIONS: This research is the first known body of work to apply the concept of INRT to limited-stage DLBCL. Reducing the field size from IFRT to INRT≤5 cm maintains a low marginal recurrence risk with no impact on overall outcome.
BACKGROUND: For limited-stage diffuse large B-cell lymphoma (DLBCL), treatment decisions are often influenced by toxicity profiles. One strategy that minimizes chemotherapy-induced toxicities is abbreviated chemotherapy plus consolidation involved-field radiotherapy (IFRT). Involved-node radiotherapy (INRT) is a new concept to DLBCL, aimed to reduce radiotherapy-induced toxicities. We retrospectively review the long-term outcomes of limited-stage DLBCL treated with abbreviated systemic therapy and radiotherapy focusing on field size: IFRT versus INRT. METHODS: The British Columbia Cancer Agency Lymphoid Cancer Database was used to identify patients diagnosed with limited-stage DLBCL (stage I/II, without B-symptoms; bulk < 10 cm) from 1981 to 2007. Patients were prescribed 3 cycles of chemotherapy plus IFRT (1981-1996) or INRT≤5 cm (1996-2007), defined as INRT to the prechemotherapy involved nodes with margins ≤ 5 cm. RESULTS: A total of 288 patients were identified: 56% were aged >60 years, 34% had stage II disease, 55% had extranodal disease, 19% had elevated lactate dehydrogenase levels, and 15% received rituximab. The two radiotherapy groups were IFRT (138 patients; 48%) and INRT≤5cm (150 patients; 52%); median follow-up was 117 and 89 months, respectively. Distant relapse was the most common site of failure in both groups. After INRT≤5 cm, marginal recurrence was infrequent (2%). Time to progression (P = .823), progression-free survival (P = .575), and overall survival (P = .417) were not significantly different between the radiotherapy cohorts. Radiotherapy field size was not a significant prognostic factor on multivariate analyses. CONCLUSIONS: This research is the first known body of work to apply the concept of INRT to limited-stage DLBCL. Reducing the field size from IFRT to INRT≤5 cm maintains a low marginal recurrence risk with no impact on overall outcome.
Authors: Eva Holzhäuser; Maximilian Berlin; Daniel Wollschläger; Thomas Bezold; Arnulf Mayer; Georg Heß; Heinz Schmidberger Journal: Strahlenther Onkol Date: 2017-07-26 Impact factor: 3.621
Authors: Ulrich Jaeger; Marek Trneny; Helen Melzer; Michael Praxmarer; Weerasak Nawarawong; Dina Ben Yehuda; David Goldstein; Bilijana Mihaljevic; Osman Ilhan; Veronika Ballova; Michael Hedenus; Liang-Tsai Hsiao; Wing-Yan Au; Sonja Burgstaller; Gerhard Weidinger; Felix Keil; Christian Dittrich; Cathrin Skrabs; Anton Klingler; Andreas Chott; Michael A Fridrik; Richard Greil Journal: Haematologica Date: 2015-04-24 Impact factor: 9.941
Authors: George Daniel Grass; Matthew N Mills; Kamran A Ahmed; Casey L Liveringhouse; Michael E Montejo; Timothy J Robinson; Julio C Chavez; Louis B Harrison; Sungjune Kim Journal: Leuk Lymphoma Date: 2018-11-20
Authors: Pallawi Torka; Shalin K Kothari; Suchitra Sundaram; Shaoying Li; L Jeffrey Medeiros; Emily C Ayers; Daniel J Landsburg; David A Bond; Kami J Maddocks; Anshu Giri; Brian Hess; Luu Q Pham; Ranjana Advani; Yang Liu; Stefan Klaus Barta; Julie M Vose; Michael C Churnetski; Jonathon B Cohen; Madelyn Burkart; Reem Karmali; Joanna Zurko; Amitkumar Mehta; Adam J Olszewski; Sarah Lee; Brian T Hill; Timothy F Burns; Frederick Lansigan; Emma Rabinovich; David Peace; Adrienne Groman; Kristopher Attwood; Francisco J Hernandez-Ilizaliturri Journal: Blood Adv Date: 2020-01-28
Authors: Deborah M Stephens; Hongli Li; Michael L LeBlanc; Soham D Puvvada; Daniel Persky; Jonathan W Friedberg; Sonali M Smith Journal: J Clin Oncol Date: 2016-07-05 Impact factor: 44.544