Consolidation Radiotherapy to Bulky or Semibulky Lesions in the Management of Stage III–IV Diffuse Large B Cell Lymphomas

Abstract

Background: To assess the impact on survival of consolidation radiotherapy to bulky or semibulky lesions in patients with advanced diffuse large B cell lymphoma (DLCL) in complete remission after primary chemotherapy. Patients and Methods: Ninety-four patients with stage III–IV DLCL and bulky (≥10 cm) or semibulky lesions (6–9 cm) in complete remission after primary chemotherapy were reviewed. Forty patients received consolidation radiotherapy to bulky (n = 20) or semibulky lesions (n = 20), while 54 (18 with bulky disease) did not. Twenty-eight patients were irradiated to the involved field and 12 to the extended field with a dose of 30–46 Gy. Results: In patients with bulky disease, consolidation radiotherapy prevented relapses involving exclusively the bulky area, prolonged time to relapse (TTR) (median 41+ vs. 18 months; p = 0.05) and improved 5-year overall survival (OS) (73 vs. 57%; p = 0.05). Consolidation radiotherapy reduced relapses within the semibulky area, prolonged TTR (median 26+ vs. 20 months; p = 0.01) and improved 5-year OS (59 vs. 41%; p = 0.09) also in patients with semibulky lesions. Multivariate analyses confirmed the independent association between consolidation radiotherapy and survival, and showed that a dose ≥36 Gy was related to a longer OS, while the extension of the radiotherapy field did not modify outcome. No treatment-related deaths were observed. Four patients developed a second malignancy, none of whom had undergone consolidation radiotherapy. Conclusions: Consolidation radiotherapy to bulky or semibulky lesions significantly improved the outcome in patients with advanced DLCL in complete remission after primary chemotherapy. Involved-field irradiation with 36–45 Gy made a prolonged disease control possible without either lethal toxicity or a higher incidence of second malignancies.

A Systematic Overview of Radiation Therapy Effects in Non-Hodgkin's Lymphoma

“…However, these results were recently confirmed by a retrospective Italian study. Overall survival was significantly superior after consolidation radiotherapy in patients with advanced aggressive NHL and initially bulky disease in complete remission after chemotherapy compared to no radiotherapy (29).…”

Middle Ear Mass With Facial Weakness

“…Radiation therapy is dependent on site involvement and may be used for advanced bulky disease. 8 In summary, this case represents a B-cell lymphoma presenting as a middle ear mass. Although on initial examination facial nerve function was normal, the patient's history of facial weakness and the presence of otalgia raised suspicion for a malignant neoplasm.…”

Czy należy stosować radioterapię w nieziarniczym rozlanym chłoniaku z dużych komórek B? Głos na tak

“…Natomiast rola radioterapii jest marginalna. Wpływ napromieniania zmian resztkowych po leczeniu systemowym bez rytuksymabu u chorych z guzami > 10 cm oceniono w kilku prospektywnych i retrospektywnych badaniach [29][30][31][32][33], a po leczeniu R-CHOP w trzech retrospektywnych badaniach z MDACC i Duke University oraz Emory University [34][35][36]. We wszystkich wykazano korzyść z radioterapii w odniesieniu do pięcioletniej kontroli miejscowej, czasu do progresji, a także w odniesieniu do ogólnego czasu przeżycia.…”