Naresh Jegadeesh1, Raj Rajpara1, Natia Esiashvili1, Zheng Shi1, Yuan Liu2, Derrick Okwan-Duodu1, Christopher R Flowers3, Mohammad K Khan4. 1. Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia. 2. Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, Georgia. 3. Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Medical Oncology, Emory University, Atlanta, Georgia. 4. Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia. Electronic address: drkhurram2000@gmail.com.
Abstract
PURPOSE: The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (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: Two hundred eleven patients with stage III and IV DLBCL 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: The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥ 5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥ 5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥ 15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV ≥ 15 (P=.10). CONCLUSIONS: Advanced-stage DLBCL patients with stage III disease 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 after chemoimmunotherapy.
PURPOSE: The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (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: Two hundred eleven patients with stage III and IV DLBCL 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: The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥ 5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥ 5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥ 15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV ≥ 15 (P=.10). CONCLUSIONS: Advanced-stage DLBCL patients with stage III disease 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 after chemoimmunotherapy.
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