Definitive radiotherapy for localized follicular lymphoma staged by18F-FDG PET-CT: A collaborative study by ILROG Journal Article


Authors: Brady, J. L.; Binkley, M. S.; Hajj, C.; Chelius, M.; Chau, K.; Balogh, A.; Levis, M.; Filippi, A. R.; Jones, M.; Manus, M. M.; Wirth, A.; Oguchi, M.; Vistisen, A. K.; Andraos, T. Y.; Ng, A. K.; Aleman, B. M. P.; Choi, S. H.; Kirova, Y.; Hardy, S.; Reinartz, G.; Eich, H. T.; Bratman, S. V.; Constine, L. S.; Suh, C. O.; Dabaja, B.; El-Galaly, T. C.; Hodgson, D. C.; Ricardi, U.; Yahalom, J.; Hoppe, R. T.; Mikhaeel, N. G.
Article Title: Definitive radiotherapy for localized follicular lymphoma staged by18F-FDG PET-CT: A collaborative study by ILROG
Abstract: Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50%. As18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60% of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ‡24 Gy, staged by PET-CT, age ‡18 years, and follow-up ‡3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1%) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9% and 95.7%. For stage I, FFP was 74.1% vs 49.1% for stage II (P < .0001). Eight patients relapsed in-field (1.6%). Four had marginal recurrences (0.8%) resulting in local control rate of 97.6%. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95% CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated. © 2019 by The American Society of Hematology.
Journal Title: Blood
Volume: 133
Issue: 3
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2019-01-17
Start Page: 237
End Page: 245
Language: English
DOI: 10.1182/blood-2018-04-843540
PUBMED: 30446493
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 February 2019 -- Source: Scopus
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MSK Authors
  1. Joachim Yahalom
    391 Yahalom
  2. Carla Hajj
    30 Hajj
  3. Monica Rose Chelius
    10 Chelius
  4. Karen Chau
    14 Chau