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Limited‐stage diffuse large B‐cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy
Author(s) -
Campbell Belinda A.,
Connors Joseph M.,
Gascoyne Randy D.,
Morris W. James,
Pickles Tom,
Sehn Laurie H.
Publication year - 2012
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.26687
Subject(s) - medicine , radiation therapy , diffuse large b cell lymphoma , stage (stratigraphy) , oncology , rituximab , chemotherapy , lymphoma , b symptoms , surgery , paleontology , biology
BACKGROUND: For limited‐stage diffuse large B‐cell lymphoma (DLBCL), treatment decisions are often influenced by toxicity profiles. One strategy that minimizes chemotherapy‐induced toxicities is abbreviated chemotherapy plus consolidation involved‐field radiotherapy (IFRT). Involved‐node radiotherapy (INRT) is a new concept to DLBCL, aimed to reduce radiotherapy‐induced toxicities. We retrospectively review the long‐term outcomes of limited‐stage DLBCL treated with abbreviated systemic therapy and radiotherapy focusing on field size: IFRT versus INRT. METHODS: The British Columbia Cancer Agency Lymphoid Cancer Database was used to identify patients diagnosed with limited‐stage DLBCL (stage I/II, without B‐symptoms; bulk < 10 cm) from 1981 to 2007. Patients were prescribed 3 cycles of chemotherapy plus IFRT (1981‐1996) or INRT≤5 cm (1996‐2007), defined as INRT to the prechemotherapy involved nodes with margins ≤ 5 cm. RESULTS: A total of 288 patients were identified: 56% were aged >60 years, 34% had stage II disease, 55% had extranodal disease, 19% had elevated lactate dehydrogenase levels, and 15% received rituximab. The two radiotherapy groups were IFRT (138 patients; 48%) and INRT≤5cm (150 patients; 52%); median follow‐up was 117 and 89 months, respectively. Distant relapse was the most common site of failure in both groups. After INRT≤5 cm, marginal recurrence was infrequent (2%). Time to progression ( P = .823), progression‐free survival ( P = .575), and overall survival ( P = .417) were not significantly different between the radiotherapy cohorts. Radiotherapy field size was not a significant prognostic factor on multivariate analyses. CONCLUSIONS: This research is the first known body of work to apply the concept of INRT to limited‐stage DLBCL. Reducing the field size from IFRT to INRT≤5 cm maintains a low marginal recurrence risk with no impact on overall outcome. Cancer 2012. © 2012 American Cancer Society.