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Title: Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging

Abstract

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, pmore » = 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.« less

Authors:
 [1];  [1];  [2]; ;  [3];  [4];  [1]
  1. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)
  2. Cancer Statistical Center, Duke University Medical Center, Durham, North Carolina (United States)
  3. Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina (United States)
  4. Department of Radiology, Division of Nuclear Medicine, Duke University Medical Center, Durham, North Carolina (United States)
Publication Date:
OSTI Identifier:
22149586
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANTIBODIES; CHEMOTHERAPY; DOXORUBICIN; ENDOXAN; FAILURES; HEALTH HAZARDS; LYMPHOMAS; MULTIVARIATE ANALYSIS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; PREDNISONE; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Dorth, Jennifer A., E-mail: jennifer.dorth@duke.edu, Prosnitz, Leonard R., Broadwater, Gloria, Diehl, Louis F., Beaven, Anne W., Coleman, R. Edward, and Kelsey, Chris R. Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.12.067.
Dorth, Jennifer A., E-mail: jennifer.dorth@duke.edu, Prosnitz, Leonard R., Broadwater, Gloria, Diehl, Louis F., Beaven, Anne W., Coleman, R. Edward, & Kelsey, Chris R. Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging. United States. doi:10.1016/J.IJROBP.2011.12.067.
Dorth, Jennifer A., E-mail: jennifer.dorth@duke.edu, Prosnitz, Leonard R., Broadwater, Gloria, Diehl, Louis F., Beaven, Anne W., Coleman, R. Edward, and Kelsey, Chris R. Thu . "Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging". United States. doi:10.1016/J.IJROBP.2011.12.067.
@article{osti_22149586,
title = {Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging},
author = {Dorth, Jennifer A., E-mail: jennifer.dorth@duke.edu and Prosnitz, Leonard R. and Broadwater, Gloria and Diehl, Louis F. and Beaven, Anne W. and Coleman, R. Edward and Kelsey, Chris R.},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2011.12.067},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}