Premium
Impact of salvage treatment modalities in patients with positive FDG‐PET/CT after R‐CHOP chemotherapy for aggressive B‐cell non‐Hodgkin lymphoma
Author(s) -
Chin Vicky,
Fulham Michael,
Hertzberg Mark,
Jackson Michael,
Lindeman Robert,
Brighton Timothy,
KidsonGerber Giselle,
Wegner Eva A,
Cheung Carol,
MacCallum Susan,
Williams Janet,
Thompson Stephen R
Publication year - 2018
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12719
Subject(s) - medicine , salvage therapy , chemotherapy , chop , lymphoma , oncology , surgery
To compare outcomes of different salvage treatment modalities in patients with aggressive B‐cell non‐Hodgkin lymphoma ( NHL ) who remain FDG ‐ PET positive after R‐ CHOP chemotherapy. Existing data on these patients with FDG ‐ PET primary refractory disease are limited. Methods Patients with diffuse large B‐cell lymphoma or grade 3 follicular lymphoma were retrospectively reviewed from the Prince of Wales Hospital databases. Eligibility criteria were: age≥18 years, treated with R‐ CHOP , with positive post‐chemotherapy FDG ‐ PET . Salvage treatment modalities were: radical radiotherapy ( RT , dose≥30 Gy), high dose chemotherapy and autologous stem cell transplant ( ASCT ), or non‐radical management. Survival was calculated from date of post‐chemotherapy FDG ‐ PET to last follow‐up. Results Twenty‐six patients from 2003–2015 met the inclusion criteria. Median age was 60 (range 19–84). Most had adverse baseline features: 21 (81%) stage III ‐ IV , 24 (92%) bulky disease and nine (35%) skeletal involvement. Characteristics of PET ‐positivity post‐chemotherapy were single site in 16 (62%), sites of prior bulk in 24 of 24, skeletal sites in five of nine, and able to be encompassed by RT in 21 (81%). Salvage treatment was: radical RT in 17 (65%), ASCT in four (15%) and non‐radical in five (20%). Median follow‐up of surviving patients was 31 months. Kaplan–Meier estimates of 3‐year PFS and OS were 41% and 52%, respectively. By salvage modality, 3‐year PFS was 51% for RT , 25% for ASCT and 20% for non‐radical treatment, ( P = 0.453); 3‐year OS was respectively 65%, 25% and 40% ( P = 0.173). Conclusion Patients with FDG ‐ PET positive disease after R‐ CHOP for aggressive B‐cell NHL are salvageable with radiotherapy.