Mediastinal relapse remains the most common cause of failure in mediastinal T-cell lymphoblastic lymphoma (LL). To investigate the role of mediastinal radiation therapy (XRT) after complete response to chemotherapy, we reviewed 49 patients (pts) with mediastinal T-cell LL with or without marrow involvement, who presented between 1980 and 1998. Forty five pts achieved complete remission (CR) and were the subject of this analysis. Median age was 27 years; 33(73%) were males. Marrow involvement was present in 16 pts (36%), leukemic phase in 5 (11%), nodal involvement in 20 (44%), hepatosplenomegaly in 5 (11%), pleural effusion in 21(47%). The initial chemotherapy regimens were: Hyper CVAD in 20, CVAD in 11, CHOP in 5, other in 5. Twenty patients received adjuvant mediastinal XRT, dose ranges 26-39 Oy. There was no difference in patient characteristics between the 20 pts treated with XRT vs 25 pts not treated with XRT. Median follow up for all pts was 43 months. Five-year overall survival rate (OS) was 65% and freedom from progression (FFP) 59%. Five of 20(25%) pts in the group that received XRT relapsed, all outside the mediastinum (2 in marrow, 2 in central nervous system (CNS), and 1 in both marrow and CNS). One of 5 is alive and in no evidence of disease(NED) at last follow-up. This is compared to 12 of 25(48%) pts that relapsed in the group who did not receive XRT (5 in the mediastinum as the sole site, 4 in marrow, 2 in marrow and mediastinum and 1 in CNS). Two of 12 are alive and NED at last follow up. Thus mediastinal relapse occurred in 0/20 with XRT vs 7/25 without XRT. Patients treated with mediastinal XRT had significantly better mediastinal FFP (p=0.0093) but the differences in the overall FFP and OS were not significant (p=0.149 and p=0.143 respectively). Bone marrow involvement, bulkiness of mediastinal mass, presence of pleural effusion did not affect the FFP or OS. In summary local radiotherapy significantly increases the local freedom from progression in adult with mediastinal T-cell lymphoblastic lymphoma.
|Original language||English (US)|
|Issue number||11 PART II|
|State||Published - Dec 1 2000|
ASJC Scopus subject areas
- Cell Biology