Limited Chemotherapy and Shrinking Field Radiotherapy for Osteolymphoma (Primary Bone Lymphoma): Results From the Trans-Tasman Radiation Oncology Group 99.04 and Australasian Leukaemia and Lymphoma Group LY02 Prospective Trial

Christie, David; Dear, Keith; Le, Thai‐Ha; Bartoň, Michael; Wirth, Andrew; Porter, David; Roos, Daniel; Pratt, Gary

doi:10.1016/j.ijrobp.2010.03.036

Cited by 35 publications

(34 citation statements)

References 17 publications

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“…Some authors report an increased incidence of fractures after radiotherapy [23,24], and this could lead to a preference for early stabilisation of the affected bones. In our series, no fracture occurred after radiation treatment, a result similar to those reported by other authors who explored this subject [10,17].…”

Section: Discussionsupporting

confidence: 92%

“…Little is reported about surgical procedures, even if surgery does, in some cases, become necessary for fractures or impending fractures. An incidence of orthopaedic surgical procedures other than biopsy, ranging from 13.8 % to 26 % [7][8][9][10] or even 47 % [5], is reported, but most papers either do not mention incidence or type of surgery [4,6,[11][12][13][14][15] or report incomplete data about the surgery performed [16,17]. Therefore, we decided to review our series in a single-centre, consecutive series of patients affected by primary bone lymphoma with the aim of: (1) evaluating incidence of surgery , (2) examining type of surgery and its combination with adjuvant treatment and (3) evaluating whether surgery should precede or follow radiotherapy and chemotherapy treatment.…”

Section: Introductionmentioning

confidence: 99%

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Primary lymphoma of bone: outcome and role of surgery

Scoccianti

Rigacci

Puccini

et al. 2013

International Orthopaedics (SICOT)

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Purpose Primary bone lymphoma is a rare disease. Little is reported about surgical procedures in these patients. We evaluated a single-centre consecutive series of 21 patients for results, prognostic factors and surgical treatment. Methods Patient ages ranged from 19 to 82 years. The most frequently affected site was the spine (six cases), followed by the ileum, femur and mandible (three cases each). Four patients were treated with chemotherapy and 17 with chemotherapy and radiation therapy. Six patients were affected by a pathological fracture. Surgery was performed in four patients (19 %), in two cases before chemotherapy, in one case during chemotherapy and in one case after chemotherapy and radiotherapy. Five patients died within the range of three to 36 months after diagnosis. Average follow-up of the remaining patients was 62.8 (19-145) months. Results Overall survival was 74.2 % at five years. The only positive prognostic factor was complete remission after chemotherapy. A trend for better survival was present for International Prognostic Index (IPI) score (P =0.051), under 40 years of age (P =0.10) and abnormal lactate dehydrogenase (LDH) values (P =0.10), but it did not reach statistical significance. Conclusions Surgical treatment should be aimed at restoring function and eliminating pain while minimising delays in the chemotherapy schedule. When feasible, postponing surgery until after chemotherapy is advisable.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Primary lymphoma of bone: outcome and role of surgery

Scoccianti

Rigacci

Puccini

et al. 2013

International Orthopaedics (SICOT)

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“…In this study, PBL was generally treated with multimodality treatment, and relatively poor results were achieved with local radiation therapy alone. However, a recent report of a prospective study from Australia showed high rates of survival and considerable local failure when the patients were treated with limited chemotherapy and shrinking field radiotherapy, lending support to the disease nature involving initially local bone disease with later systemic dissemination (24).…”

Section: Discussionmentioning

confidence: 98%

Prognostic Factors and Treatment Efficacy in Patients with Primary Diffuse Large B-cell Lymphoma of the Bone: Single Institute Experience Over 11 Years

Liu

Gau

et al. 2014

Intern. Med.

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Objective Primary bone lymphoma is a rare disorder, accounting for less than 1% of all cases of malignant lymphoma. Primary bony diffuse large B-cell lymphoma (PBDLBCL) is the most common histological type. In our study, a favorable response and lower risk of emergent surgery were observed following the administration of systemic chemotherapy with or without rituximab. Methods Patients diagnosed with malignant lymphoma at our hospital between 2000 and 2011 were evaluated for PBDLBCL. Pertinent data, including the clinical presentation, histological type, treatment modalities, long-term outcome, survival curve and prognostic factors, were analyzed. Results Twenty-four patients with a median age of 63 years were diagnosed with PBDLBCL. A complete response (CR) was achieved in 58.4% (n=14) of the patients. With treatment of the disease, nine of 10 patients with initially impending pathological bone fractures ultimately did not undergo surgery. The median follow-up duration was 48 months. Two patients experienced disease relapse. In a Kaplan-Meier analysis, the 5-year overall survival (OS) and disease-free survival (DFS) rates were 66.7% and 77.8%, respectively. In the univariate analyses, the significantly favorable prognostic factors for OS were an International Prognostic Index (IPI) score of <3, an age of 60 years, a performance status with an Eastern Cooperative Oncology (ECOG) score of <2, a CR and chemotherapy 6 cycles. For DFS, a CR was the only favorable factor. In the multivariate analysis, a CR was the only independent factor for both OS and DFS. Conclusion Our study confirms the good prognosis of this rare disorder. Once a CR is achieved, even elderly patients may exhibit long-term survival, possibly obviating the need for surgery for less severe bone lesions.

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“…The efficacy of radiation as an adjunct came under question in lieu of recent studies demonstrating excellent survival outcomes with systemic therapy alone, particularly with the addition of rituximab [1,12,13,41]. Several studies, however, have continued to support the continued use of radiation combined with chemotherapy in adults (CMT) [5,14,28,40]. Management of patients with NHL of bone has become largely nonoperative, but surgical intervention remains critical in the management of disease-related complications as well as complications associated with treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The departments of pathology and hematology/oncology were queried to identify cases of bone lymphoma diagnosed at our institution between 1985 and 2013. Criteria for patient inclusion in our study were biopsy-proven NHL occurring in bone and a minimum clinical followup of 6 months [14,16]. Criteria for exclusion included (1) unclear diagnosis; (2) diagnosis of Hodgkin's lymphoma; and (3) diagnosis of T-cell lymphoma.…”

Section: Methodsmentioning

confidence: 99%

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

Ibrahim

Haughom

Fillingham

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Non-Hodgkin's lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy.Questions/purposes The objective of this study was to compare patients treated for NHL of bone with and without radiation in terms of (1) overall survival; (2) pretreatment complications; (3) posttreatment complications; and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. Methods A retrospective analysis of all patients with biopsy-proven NHL of bone diagnosed at our institution between 1985 and 2013 was undertaken; 70 patients met our criteria for inclusion with minimum followup of 6 months (median, 55 months; range, 10-219 months). Overall survival at 5 and 10 years was estimated and compared between two groups of patients: one group treated with systemic therapy alone (chemotherapy, rituximab; 46 patients [66%]) and the other with combined modality therapy (systemic therapy and radiotherapy; 24 patients [34%]). During the period in question, indications for radiotherapy included bulky disease, an abbreviated course of systemic therapy, and an incomplete response to systemic therapy. Patients not meeting these criteria generally received systemic therapy alone. With the available sample size, it was estimated that a difference in survival of approximately 30% would have to be present for detection with 80% power (a = 0.05, b = 0.2, n = 70, D = 30%). Pretreatment and posttreatment complications occurring in both patient groups were retrospectively reviewed with special emphasis on fracture healing after treatment. MSTS scores were obtained for 45 patients with appendicular tumors at a median followup of 42 months (range, 10-215 months). Results With the data available, no difference in KaplanMeier survivorship was observed between patients treated with and without radiation at 5 years (98%; 95% confidence interval [CI], 93%-100% versus 95%; 95% CI, 85%-100%; p = 0.281). Patients who were treated with radiation were

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Limited Chemotherapy and Shrinking Field Radiotherapy for Osteolymphoma (Primary Bone Lymphoma): Results From the Trans-Tasman Radiation Oncology Group 99.04 and Australasian Leukaemia and Lymphoma Group LY02 Prospective Trial

Cited by 35 publications

References 17 publications

Primary lymphoma of bone: outcome and role of surgery

Primary lymphoma of bone: outcome and role of surgery

Prognostic Factors and Treatment Efficacy in Patients with Primary Diffuse Large B-cell Lymphoma of the Bone: Single Institute Experience Over 11 Years

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

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