AbstractObjective To investigate the impacts of adjuvant radiotherapy on the prognosis of patients with stage Ⅰ—Ⅱ diffuse large B cell lymphoma of Waldeyer’s ring (WR-DLBCL) who achieved complete remission (CR) after chemotherapy. Methods Clinical data were collected from 130 patients with stage Ⅰ—Ⅱ WR-DLBCL who were admitted to our hospital from 2005 and 2013. All the patients achieved CR after at least two cycles of cyclophosphamide,doxorubicin/epirubicin,vincristine,and prednisone (CHOP)-based chemotherapy or rituximab plus CHOP (R-CHOP)-based chemotherapy. In the 130 patients,43 received R-CHOP (including 25 patients undergoing radiotherapy) and 87 CHOP (including 76 patients undergoing radiotherapy);29 received chemotherapy alone and 101 chemoradiotherapy. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate and multivariate prognostic analyses were made by the log-rank test and the Cox model,respectively. Results In all patients,the 5-year sample size was 101. The univariate analysis showed that patients with an Eastern Cooperative Oncology Group (ECOG) score of 0 had significantly higher 5-year overall survival (OS) and disease-free survival (DFS) rates than those with an ECOG score of 1(95.6% vs. 80.1%,P=0.000;95.7% vs. 75.4%,P=0.029). Patients treated with chemotherapy alone had significantly lower 5-year OS and DFS rates than those treated with chemoradiotherapy (77.1% vs. 91.7%,P=0.048;77% vs. 87.4%,P=0.037). The multivariate analysis by the Cox model showed that ECOG score was a prognostic factor for both OS and DFS (P=0.047,0.003). Adjuvant radiotherapy was related to improved DFS rather than OS (P=0.039,0.133). Conclusions Stage Ⅰ—Ⅱ WR-DLBCL patients with low ECOG scores have better prognosis than those with high ECOG scores. Patients with CR after chemotherapy may benefit from adjuvant radiotherapy. The conclusions need to be further confirmed by prospective randomized controlled trials.
Lu Ke,Zhu Yuan,Liu Jianjiang et al. Role of radiotherapy in patients with stage Ⅰ—Ⅱ diffuse large B-cell lymphoma of waldeyer’s ring in remission after chemotherapy[J]. Chinese Journal of Radiation Oncology, 2017, 26(2): 160-164.
Lu Ke,Zhu Yuan,Liu Jianjiang et al. Role of radiotherapy in patients with stage Ⅰ—Ⅱ diffuse large B-cell lymphoma of waldeyer’s ring in remission after chemotherapy[J]. Chinese Journal of Radiation Oncology, 2017, 26(2): 160-164.
[1] Hoppe RT,Burke JS,Glatstein E,et al. Non-Hodgkin′s lymphoma:involvement of Waldeyer′s ring[J].Cancer,1978,42(3):1096-1104. [2] Yuen A,Jacobs C.Lymphomas of the head and neck[J].Semin Oncol,1999,26(3):338-345. [3] Zelenetz AD,Gordon LI,Wierda WG,et al. Non-Hodgkin’s lymphoma,version 4.2014[J].J Natl Compr Canc Netw,2014,12(9):1282-1303. [4] Tilly H,da Silva MG,Vitolo U,et al. Diffuse large B-cell lymphoma (DLBCL):ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2015,26(S5):v116-125.DOI:10.1093/annonc/mdv304. [5] Carbone PP,Kaplan HS,Musshoff K,et al. Report of the committee on Hodgkin’s disease staging classification[J].Cancer Res,1971,31(11):1860-1861. [6] Miller TP,Dahlberg S,Cassady JR,et al. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate-and high-grade non-Hodgkin′s lymphoma[J].N Engl J Med,1998,339(1):21-26.DOI:10.1056/ NEJM199807023390104. [7] Horning SJ,Weller E,Kim K,et al. Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkin′s lymphoma:eastern cooperative oncology group study 1484[J].J Clin Oncol,2004,22(15):3032-3038.DOI:10.1200/JCO.2004.06.088. [8] Bonnet C,Fillet G,Mounier N,et al. CHOP alone compared with CHOP plus radiotherapy for localized aggressive lymphoma in elderly patients:a study by the Groupe d’Etude des Lymphomes de l’Adulte[J].J Clin Oncol,2007,25(7):787-792.DOI:10.1200/JCO.2006.07.0722. [9] Reyes F,Lepage E,Ganem G,et al. ACVBP versus CHOP plus radiotherapy for localized aggressive lymphoma[J].N Engl J Med,2005,352(12):1197-1205.DOI:10.1056/NEJMoa042040. [10] Vargo JA,Gill BS,Balasubramani GK,et al. Treatment selection and survival outcomes in early-stage diffuse large B-Cell lymphoma:do we still need consolidative radiotherapy?[J].J Clin Oncol,2015,33(32):3710-3717.DOI:10.1200/JCO.2015.61.7654. [11] Persky DO,Unger JM,Spier CM,et al. Phase Ⅱ study of rituximab plus three cycles of CHOP and involved-field radiotherapy for patients with limited-stage aggressive B-cell lymphoma:southwest oncology group study 0014[J].J Clin Oncol,2008,26(14):2258-2263.DOI:10.1200/JCO.2007.13.6929. [12] Pfreundschuh M,Kuhnt E,Trümper L,et al. CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma:6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group[J].Lancet Oncol,2011,12(11):1013-1022.DOI:10.1016/S1470-2045(11)70235-2. [13] Phan J,Mazloom A,Medeiros LJ,et al. Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy[J].J Clin Oncol,2010,28(27):4170-4176.DOI:10.1200/JCO.2009.27.3441. [14] Dabaja BS,Vanderplas AM,Crosby-Thompson AL,et al. Radiation for diffuse large B-cell lymphoma in the rituximab era:analysis of the National Comprehensive Cancer Network lymphoma outcomes project[J].Cancer,2015,121(7):1032-1039.DOI:10.1002/cncr.29113. [15] 刘建江,张娜,刘鲁迎,等.放疗对早期弥漫大B细胞淋巴瘤化疗后CR患者的价值研究[J].中华放射肿瘤学杂志,2015,24(2):138-142.DOI:10.3760/cma.j.issn.1004-4211.2015.02.000. Liu JJ,Zhang N,Liu LY,et al. Clinical value of radiotherapy in early DLBCL patients with complete remission after chemotherapy[J].Chin J Radiat Oncol,2015,24(2):138-142.DOI:10.3760/cma.j.issn.1004-4211.2015.02.000. [16] Campbell BA,Connors JM,Gascoyne RD,et al. Limited-stage diffuse large B-cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy:involved-field versus involved-node radiotherapy[J].Cancer,2012,118(17):4156-4165.DOI:10.1002/cncr.26687. [17] Verhappen MH,Poortmans PMP,Raaijmakers E,et al. Reduction of the treated volume to involved node radiation therapy as part of combined modality treatment for early stage aggressive non-Hodgkin′s lymphoma[J].Radiother Oncol, 2013,109(1):133-139.DOI:10.1016/j.radonc.2013.07.013. [18] Lowry L,Smith P,Qian WD,et al. Reduced dose radiotherapy for local control in non-Hodgkin lymphoma:a randomised phase Ⅲ trial[J].Radiother Oncol, 2011,100(1):86-92.DOI:10.1016/j.radonc.2011.05.013. [19] Coiffier B,Lepage E,Brière J,et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma[J].N Engl J Med,2002,346(4):235-242.DOI:10.1056/NEJMoa011795. [20] Pfreundschuh M,Schubert J,Ziepert M,et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas:a randomised controlled trial (RICOVER-60)[J].Lancet Oncol,2008,9(2):105-116.DOI:10.1016/S1470-2045(08)70002-0. [21] Laskar S,Bahl G,Muckaden MA,et al. Primary diffuse large B-cell lymphoma of the tonsil:is a higher radiotherapy dose required?[J].Cancer,2007,110(4):816-823.DOI:10.1002/cncr.22841. [22] Mian M,Ferreri AJM,Rossi A,et al. Role of radiotherapy in patients with early-stage diffuse large B-cell lymphoma of Waldeyer′s ring in remission after anthracycline-containing chemotherapy[J].Leuk Lymphoma,2013,54(1):62-68.DOI:10.3109/10428194.2012.710907. [23] 徐勇刚,李晔雄,王维虎,等.利妥昔单抗时代放疗对早期韦氏环弥漫大B细胞淋巴瘤的作用价值[J].中华放射肿瘤学杂志,2015,24(5):502-505.DOI:10.3760/cma.j.issn.1004-4221.2015.04.006. Xu YG,Li YX,Wang WH,et al. Value of radiotherapy for early-stage Waldeyer’s ring diffuse large B-cell lymphoma in the rituximab era[J].Chin J Radiat Oncol,2015,24(5):502-505.DOI:10.3760/cma.j.issn.1004-4221.2015.04.006.