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Impact of consolidation radiation therapy in stage III-IV diffuse large B-cell lymphoma with negative post-chemotherapy radiologic imaging.

Publication ,  Journal Article
Dorth, JA; Prosnitz, LR; Broadwater, G; Diehl, LF; Beaven, AW; Coleman, RE; Kelsey, CR
Published in: Int J Radiat Oncol Biol Phys
November 1, 2012

PURPOSE: While consolidation radiation therapy (i.e., RT administered after chemotherapy) is routine treatment for patients with early-stage diffuse large B-cell lymphoma (DLBCL), the role of consolidation RT in stage III-IV DLBCL is controversial. METHODS AND MATERIALS: Cases of patients with stage III-IV DLBCL treated from 1991 to 2009 at Duke University, who achieved a complete response to chemotherapy were reviewed. Clinical outcomes were calculated using the Kaplan-Meier method and were compared between patients who did and did not receive RT, using the log-rank test. A multivariate analysis was performed using Cox proportional hazards model. RESULTS: Seventy-nine patients were identified. Chemotherapy (median, 6 cycles) consisted of anti-CD20 antibody rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 65%); cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP; 22%); or other (13%). Post-chemotherapy imaging consisted of positron emission tomography (PET)/computed tomography (CT) (73%); gallium with CT (14%); or CT only (13%). Consolidation RT (median, 25 Gy) was given to involved sites of disease in 38 (48%) patients. Receipt of consolidation RT was associated with improved in-field control (92% vs. 69%, respectively, p = 0.028) and event-free survival (85% vs. 65%, respectively, p = 0.014) but no difference in overall survival (85% vs. 78%, respectively, p = 0.15) when compared to patients who did not receive consolidation RT. On multivariate analysis, no RT was predictive of increased risk of in-field failure (hazard ratio [HR], 8.01, p = 0.014) and worse event-free survival (HR, 4.3, p = 0.014). CONCLUSIONS: Patients with stage III-IV DLBCL who achieve negative post-chemotherapy imaging have improved in-field control and event-free survival with low-dose consolidation RT.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 1, 2012

Volume

84

Issue

3

Start / End Page

762 / 767

Location

United States

Related Subject Headings

  • Vincristine
  • Tumor Burden
  • Tomography, X-Ray Computed
  • Rituximab
  • Retrospective Studies
  • Radiotherapy Dosage
  • Prednisone
  • Positron-Emission Tomography
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
 

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Dorth, J. A., Prosnitz, L. R., Broadwater, G., Diehl, L. F., Beaven, A. W., Coleman, R. E., & Kelsey, C. R. (2012). Impact of consolidation radiation therapy in stage III-IV diffuse large B-cell lymphoma with negative post-chemotherapy radiologic imaging. Int J Radiat Oncol Biol Phys, 84(3), 762–767. https://doi.org/10.1016/j.ijrobp.2011.12.067
Dorth, Jennifer A., Leonard R. Prosnitz, Gloria Broadwater, Louis F. Diehl, Anne W. Beaven, R Edward Coleman, and Chris R. Kelsey. “Impact of consolidation radiation therapy in stage III-IV diffuse large B-cell lymphoma with negative post-chemotherapy radiologic imaging.Int J Radiat Oncol Biol Phys 84, no. 3 (November 1, 2012): 762–67. https://doi.org/10.1016/j.ijrobp.2011.12.067.
Dorth JA, Prosnitz LR, Broadwater G, Diehl LF, Beaven AW, Coleman RE, et al. Impact of consolidation radiation therapy in stage III-IV diffuse large B-cell lymphoma with negative post-chemotherapy radiologic imaging. Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):762–7.
Dorth, Jennifer A., et al. “Impact of consolidation radiation therapy in stage III-IV diffuse large B-cell lymphoma with negative post-chemotherapy radiologic imaging.Int J Radiat Oncol Biol Phys, vol. 84, no. 3, Nov. 2012, pp. 762–67. Pubmed, doi:10.1016/j.ijrobp.2011.12.067.
Dorth JA, Prosnitz LR, Broadwater G, Diehl LF, Beaven AW, Coleman RE, Kelsey CR. Impact of consolidation radiation therapy in stage III-IV diffuse large B-cell lymphoma with negative post-chemotherapy radiologic imaging. Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):762–767.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 1, 2012

Volume

84

Issue

3

Start / End Page

762 / 767

Location

United States

Related Subject Headings

  • Vincristine
  • Tumor Burden
  • Tomography, X-Ray Computed
  • Rituximab
  • Retrospective Studies
  • Radiotherapy Dosage
  • Prednisone
  • Positron-Emission Tomography
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary