Residual Disease After Chemotherapy in Aggressive Malignant Lymphoma: The Role of Radiotherapy

Abstract

Residual disease in patients with diffuse large B-cell lymphoma after intensive chemotherapy remains a problem. Radiotherapy has been used in some retrospective studies without definitive conclusions. We report the first controlled clinical trial to define the role of radiotherapy in this setting of patients. One hundred and sixty-six patients with diagnosis of diffuse large B-cell lymphoma, high- or high-intermediate clinical risk, with residual disease (defined as tumor mass < 5 cm) were randomly assigned to received radiotherapy at the involved field, with 30 Gy delivered in 20 sessions or no radiation (control group). Median follow-up was 135 mo; patients who received radiotherapy have an better outcome. Actuarial curves at 10 yr showed that progressive-free disease was 86% and overall survival was 89%; those were statistical significant when compared to patients who did no received radiotherapy: 32% and 58% respectively, (p < 0.001). Toxicity was mild and well tolerated. We concluded that presence of residual mass after chemotherapy in patients with aggressive malignant lymphoma has a worse prognosis, and salvage radiotherapy improves outcome with mild toxicity. We feel that radiotherapy will be considered as necessary treatment in this special group of patients.

18F-FDG PET/CT for Monitoring the Response of Lymphoma to Radioimmunotherapy

“…This distribution of failure patterns outside sites of initial disease has been described after treatment of lymphoma with both radioimmunotherapy and external-beam radiation therapy (30,31). After front-line 131 I-tositumomab for follicular NHL, sites of bulky disease that completely responded were not at increased risk for recurrence (31).…”

“…After front-line 131 I-tositumomab for follicular NHL, sites of bulky disease that completely responded were not at increased risk for recurrence (31). Recurrence occurs less frequently at new sites after chemotherapy alone (30,31). These data, along with ours, suggest that the quality of the initial response may predict long-term outcome and that progressive disease or relapse may be more likely to occur at new sites of disease than at sites of previous involvement.…”

Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity

“…Although historical comparative trials suggested a possible benefit, [86][87][88] recent improvement in systemic therapy may have diminished its role. To date, there have been no randomized trials evaluating the role of consolidative radiation therapy in DLBCL in the rituximab era.…”

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.…”