Does consolidative radiotherapy improve survival in DLBCL patients?

This study analyzed the medical records of DLBCL patients who received consolidative radiotherapy (RT) after chemotherapy to determine if consolidative RT improved survival. This study concluded that consolidative RT might improve survival in DLBCL patients.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL). The most widely used treatment for this aggressive cancer is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). For those patients who have remaining tumors after chemotherapy, consolidative radiotherapy (RT) is used to eliminate remaining cancer.

Consolidative RT has been investigated in DLBCL patients with stage 1 or 2 disease with some benefits. However, the role of this treatment in advanced disease (stages 3 – 4) with remaining cancer after initial chemotherapy has not been clearly determined.

This study involved 264 DLBCL patients at varying stages of disease: 30.4% (stages 1-2) and 47.9% (stages 3-4). 21.7% of patients had extranodal disease (cancer outside of the lymph nodes). 98% of patients received chemotherapy. Of these, 76% received R-CHOEP (rituximab, cyclophosphamide, doxorubicin, vincristine, etoposide, prednisone) and 21% received CHOEP (without rituximab). The average follow-up period was 5.5 years.

The cancer-specific survival (CSS; those who did not die directly from the cancer) rate at 5 years was 69% for all patients. The overall survival (OS; time from treatment until death from any cause) rate at 5 years was 62% for all patients. 28.1% of patients showed a complete response (disappearance of all signs of cancer). 

53.1% of patients had remaining cancer after chemotherapy. Of these, 58.7% received RT and 41.3% did not. Those who received RT had a CSS rate of 89% and an OS rate of 82%. Those who did not receive RT had a CSS rate of 69% and an OS rate of 59%.

Patients with advanced disease who received RT had a CSS rate of 88% and and OS rate of 84%. Those who did not receive RT had a CSS rate of 68% and OS of 57%.

Low- and intermediate-risk patients showed the most benefit from RT, compared to high-risk patients.

This study concluded that consolidative RT might improve survival in DLBCL patients, especially for those with advanced, residual disease after chemotherapy.

This study looked back in time to analyze data. As a result, the collected data may be incomplete. Also, the patients included in this study were treated at two different hospitals that administered the radiotherapy differently. This could lead to biased results. Lastly, the use of RT for stage 3 or 4 disease was not standard during the study period, which could make it difficult to compare these results to other studies.

If you have low to intermediate risk DLBCL and remaining tumors after chemotherapy, talk to your care team about consolidative radiotherapy (RT).