Patterns of failure in advanced stage diffuse large b-cell lymphoma patients after complete response to r-chop immunochemotherapy and the emerging role of consolidative radiation therapy

Zheng Shi, Satya Das, Derick Okwan-Duodu, Natia Esiashvili, Christopher Flowers, Zhengjia Chen, Xiaojing Wang, Kun Jiang, Loretta J. Nastoupil, Mohammad K. Khan

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

The role of consolidative radiation therapy (RT) in advanced diffuse large B-cell lymphoma patients achieving complete response after R-CHOP is controversial. We retrospectively analyzed the patterns of failure for such patients and compared them with those who additionally received consolidative RT. Forty-four percent of the patients failed at initial sites after R-CHOP alone. The addition of consolidative RT was associated with increased local control, progression-free survival, Purpose: The role of consolidative radiation therapy (RT) after complete response (CR) to rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) forstage III-IV diffuse large B-cell lymphoma (DLBCL) patients is unclear. We aimed to evaluate our institutional experience when consolidative RT is delivered to initial presenting sites or bulky sites in these patients. Methods and Materials: We identified 211 histologically confirmed stage III-IV DLBCL patients who received R-CHOP from January 2000 to May 2012 at our institution. Patterns of failure for patients who achieved CR to R-CHOP were analyzed. Local control (LC), distant control (DC), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier method and compared between patients who received R-CHOP alone versus R-CHOP plus consolidative RT using the logerank test. Multivariate analyses were also performed using Cox proportional hazards model. Results: Detailed treatment records were available for 163 patients. After a median 6 cycles of R-CHOP, 110 patients (67.5%) achieved CR and were entered for analysis. Fourteen patients (12.7%) received consolidative RT. After median follow-up of 32.9 months, 43.8% of patients who received R-CHOP alone failed at the initial sites with or without distant recurrence (DR), whereas isolated DR only occurred in 3.7% of these patients. Consolidative RT was associated with significantly improved LC (91.7% vs 48.8%), DC (92.9% vs 71.9%), PFS (85.1% vs 44.2%), and OS (92.3% vs 68.5%; all Ps<.0001) at 5 years compared with patients with R-CHOP alone. On multivariate analysis, consolidative RT and nonbulky disease were predictive of increased LC and PFS, whereas bone marrow involvement was associated with increased risk of DR and worse OS. Consolidative RT was also associated with marginal improved OS.Conclusions: Forty-four percent of patients with advanced stage DLBCL failed at initial presenting sites after achieving CR to R-CHOP. Incorporation of consolidative RT as part of upfront treatment in these patients was associated with improved LC, PFS, and a trend towards improved OS.

Original languageEnglish (US)
Pages (from-to)569-577
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume86
Issue number3
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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