A multi-institutional and case-matched control study on treatment outcomes of consolidative radiotherapy after a full course of R-CHOP compared with R-CHOP alone in Stage I–II diffuse large B-cell lymphoma (KROG 17-02)

Autor: Woo Chul Kim, Jong Hoon Lee, Won Kyung Cho, Keun Yong Eom, Dongryul Oh, Jinhee Kim, Mi Joo Chung
Rok vydání: 2019
Předmět:
consolidative radiation therapy
genetic structures
Health
Toxicology and Mutagenesis
medicine.medical_treatment
Gastroenterology
0302 clinical medicine
immune system diseases
Prednisone
hemic and lymphatic diseases
Antineoplastic Combined Chemotherapy Protocols
Aged
80 and over
Radiation
Hazard ratio
Middle Aged
Treatment Outcome
Oncology
Vincristine
R-CHOP
030220 oncology & carcinogenesis
Rituximab
Lymphoma
Large B-Cell
Diffuse
medicine.drug
Adult
medicine.medical_specialty
Cyclophosphamide
diffuse large B-cell lymphoma
Disease-Free Survival
Young Adult
03 medical and health sciences
Internal medicine
medicine
Humans
Radiology
Nuclear Medicine and imaging
Aged
Neoplasm Staging
Chemotherapy
business.industry
Regular Papers
medicine.disease
Radiation therapy
Doxorubicin
Case-Control Studies
Multivariate Analysis
business
Diffuse large B-cell lymphoma
030215 immunology
Zdroj: Journal of Radiation Research
ISSN: 1349-9157
0449-3060
DOI: 10.1093/jrr/rrz043
Popis: We compared treatment outcomes between rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy alone with R-CHOP followed by consolidative radiation therapy (RT) in diffuse large B-cell lymphoma (DLBCL). We analyzed 404 patients with Stage I–II DLBCL who received six to eight cycles of R-CHOP and achieved a good response after a full course of chemotherapy. Propensity-score matching was used to assess the role of consolidative RT. The R-CHOP alone group (n = 184) was matched in a 1:2 ratio with the R-CHOP plus RT group (n = 92). Twenty-four (13.0%) of 184 patients receiving R-CHOP alone and 8 (8.7%) of 92 patients receiving R-CHOP plus RT had bulky diseases (>7.5 cm). A Deauville score of 1–2 was achieved for 159 (86.4%) of 184 patients receiving R-CHOP alone and 84 (91.3%) of 92 patients receiving R-CHOP plus RT. After a median follow-up time of 42 months, the recurrence-free survival (RFS) rate (86.7% vs 93.0%, P = 0.464) and overall survival rate (88.3% vs 95.1%, P = 0.295) at 5 years did not differ significantly between the R-CHOP alone and R-CHOP plus RT arms. In the additional multivariate analyses, large tumor size (>7.5 cm) was significantly associated with decreased RFS (hazard ratio, 2.368 and confidence interval, 1.837–6.697; P = 0.048). Consolidative radiation was not a significant factor for RFS (P = 0.563). Tumor size was a significant factor for RFS in the rituximab era. The outcome of omitting consolidative RT for good responders after six to eight cycles of R-CHOP chemotherapy was acceptable in early-stage DLBCL without a bulky disease.
Databáze: OpenAIRE
Externí odkaz: