In a nutshell
This study investigated the effectiveness of consolidative or salvage radiotherapy for patients with relapsed or refractory (does not respond to treatment) diffuse large B-cell lymphoma. This study concluded that radiotherapy is an effective option for high-risk patients.
The most widely used treatment for diffuse large B-cell lymphoma (DLBCL) is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). After this treatment, about 10 – 15% of patients develop refractory disease. Another 20 – 25% experience relapse.
Consolidative or salvage radiotherapy may be used to eliminate remaining cancer cells, or to induce a response in refractory disease. Whether radiotherapy is effective in patients with relapsed or refractory DLBCL is still under investigation.
Methods & findings
This study examined the records of 51 patients with DLBCL (68%) and primary mediastinal B-cell lymphoma (16%) who underwent radiotherapy. 33% of patients had a high tumor burden (bulky disease). 94% of patients received prior chemotherapy as first-line treatment, or for relapse. 53% received second-line (53%) chemotherapy, and 26% received a third-line (26%). The average follow-up period was 36 months.
71% of patients had complete disappearance of all signs of cancer (complete response; CR) after 3 months of treatment. Of these, 42% were in CR before radiotherapy. Overall, 88% of patients responded to treatment.
33% of patients relapsed after an average of 3.1 months. 10% of the relapses were in the area that received radiation. 47% of these patients had been in CR after radiotherapy.
Five-year progression-free survival (time from treatment until disease progression) was 62%. Five-year overall survival (time from treatment until death from any cause) was 72%.
Certain factors were associated with an increased risk of shorter survival. These included relapse after radiotherapy (12.24-fold) and age over 70 years (5.06-fold). Undergoing less than 3 lines of chemotherapy, as well as bulky disease, was associated with an improved overall survival.
Most of the reported side effects were mild. These included diarrhea, inflammation the mucous membranes, and problems swallowing.
The bottom line
This study concluded that radiotherapy is a viable option for high-risk patients, either as a treatment or consolidative therapy. The authors suggest that patients with bulky disease or chemo-sensitive disease would benefit most from radiotherapy.
The fine print
This study was retrospective, meaning it looked back in time to analyze data. The patient population was also quite small.
Published By :
European Journal of Haematology
Apr 16, 2018
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