Radiation for diffuse large B-cell lymphoma in the rituximab era: Analysis of the National Comprehensive Cancer Network lymphoma outcomes project Journal Article

Authors: Dabaja, B. S.; Vanderplas, A. M.; Crosby-Thompson, A. L.; Abel, G. A.; Czuczman, M. S.; Friedberg, J. W.; Gordon, L. I.; Kaminski, M.; Niland, J.; Millenson, M.; Nademanee, A. P.; Zelenetz, A.; LaCasce, A. S.; Rodriguez, M. A.
Article Title: Radiation for diffuse large B-cell lymphoma in the rituximab era: Analysis of the National Comprehensive Cancer Network lymphoma outcomes project
Abstract: BACKGROUND The role of consolidation radiotherapy was examined for patients with diffuse large B-cell lymphoma who were treated at institutions of the National Comprehensive Cancer Network during the rituximab era. METHODS Failure-free survival (FFS) and overall survival (OS) were analyzed in terms of patient and treatment characteristics. Potential associations were investigated with univariate and multivariate survival analysis and matched pair analysis. RESULTS There were 841 patients, and most (710 or 84%) received 6 to 8 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); 293 (35%) received consolidation radiation therapy (RT). Failure occurred for 181 patients: 126 patients (70%) who did not receive RT and 55 patients (30%) who did. At 5 years, both OS and FFS rates were better for patients who had received RT versus those who did not (OS, 91% vs 83% [P = .01]; FFS, 83% vs 76% [P = .05]). A matched pair analysis (217 pairs matched by age, stage, International Prognostic Index [IPI] score, B symptoms, disease bulk, and response to chemotherapy) showed that the receipt of RT improved OS (hazard ratio [HR], 0.53 [P = .07]) and FFS (HR, 0.77 [P = .34]) for patients with stage III/IV disease, but too few events took place among those with stage I/II disease for meaningful comparisons (HR for OS, 0.94 [P = .89]; HR for FFS, 1.81 [P = .15]). A multivariate analysis suggested that the IPI score and the response to chemotherapy had the greatest influence on outcomes. CONCLUSIONS There was a trend of higher OS and FFS rates for patients who had received consolidation RT after R-CHOP (especially for patients with stage III/IV disease), but the difference did not reach statistical significance. Cancer 2014. © 2014 American Cancer Society.
Keywords: survival; adult; cancer chemotherapy; controlled study; treatment response; survival rate; treatment failure; major clinical study; overall survival; prednisone; doxorubicin; conference paper; cancer radiotherapy; methotrexate; rituximab; cancer staging; positron emission tomography; computer assisted tomography; multiple cycle treatment; radiation; cyclophosphamide; vincristine; age; cause of death; symptom; computer assisted emission tomography; remission; multivariate analysis; large cell lymphoma; univariate analysis; international prognostic index; consolidation; early stage; failure free survival; human; male; female; priority journal; and prednisone (r-chop); consolidation radiation therapy; matched pair survival analysis
Journal Title: Cancer
Volume: 121
Issue: 7
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2015-04-01
Start Page: 1032
End Page: 1039
Language: English
DOI: 10.1002/cncr.29113
PROVIDER: scopus
PUBMED: 25492236
PMCID: PMC5531172
Notes: Export Date: 4 May 2015 -- Source: Scopus
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MSK Authors
  1. Andrew D Zelenetz
    550 Zelenetz