Is there a role for consolidative radiotherapy in the treatment of aggressive and localized Non-Hodgkin Lymphoma? A systematic review with meta-analysis

Abstract

Background Chemotherapy is the mainstay of non-Hodgkin lymphoma (NHL) treatment. Based on expert opinion, the use of radiotherapy (RT) is currently preferred in some institutions as consolidative treatment for patients with localized disease. The lack of conclusive data coming from conflicting studies about the impact of treatment demands a systematic review, which could provide the most reliable assessment for clinical decision-making. We evaluate the addition of RT post-CT, for aggressive and localized NHL (ALNHL). Methods Randomized controlled trials (RCT) that evaluated chemotherapy alone versus chemotherapy plus RT were searched in databases. The outcomes were overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicity. Risk ratio (RR) and hazard ratio (HR) with their respective 95% confidence intervals (CI) were calculated using a fized-effect model. Results Four trials (1,796 patients) met the inclusion criteria. All trials tested the use of RT after systemic therapy comprising anthracycline-based chemotherapy. This systematic review showed that RT enhances PFS after chemotherapy (hazard ratio [HR] 0.81; 95% CI 0.67-0.98; p = 0.03), with no impact on ORR and OS. Some heterogeneity between trials could limit the conclusions about OS. Toxicity data could not be pooled due to differences in reporting adverse events. Conclusions This systematic review with meta-analysis shows no improvement in survival when adding RT to systemic therapy for ALNHL. Our conclusions are limited by the available data. Further evaluations of new RT technologies and its association with biologic agents are needed.

Analysis of treatment outcomes for primary tonsillar lymphoma

“…Although there is controversy regarding the consolidative role of RT, several studies have shown that the addition of RT to chemotherapy improves PFS for patients with NHL [7-9,11]. Laskar et al [13] demonstrated that disease-free survival (DFS) and OS rates are higher in patients treated with chemotherapy combined with RT than in those treated with chemotherapy alone.…”

“…Several studies have shown that RT prolongs progression-free survival (PFS) [8,9]. However, in long-term follow-up studies involving the use of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), the role of RT requires clarification [10-12].…”

Risk factors and patterns of lymph node involvement in primary gastric large B-cell lymphoma: implications for target definition

“… 17 – 20 A systematic review conducted by Santos et al showed that radiation could enhance progression-free survival after chemotherapy. 21 Therefore, since nodal DLBCL and PG-DLBCL share many of the same biological characteristics, systemic chemotherapy followed by radiotherapy is now the preferred treatment for PG-DLBCL in certain centers. Evidence from retrospective data also confirmed that the addition of radiation significantly reduced the local relapse rate compared with chemotherapy alone.…”

Primary Non-Hodgkins Lymphoma of Uterine Cervix: A Case Report of Two Patients

“…Radiotherapy is considered if there is bulky disease at presentation. For aggressive localized NHL, the addition of radiotherapy postchemotherapy does not seem to offer any benefit in progression free or overall survival [3].…”