![]() ![]() Given that as many as two-thirds of patients present with advanced-stage disease and 10-year overall survival (OS) for stage II-IV patients receiving R-CHOP alone is reported at 43.5% further efforts are warranted to improve outcomes for this patient subset. ![]() Recently, other regimens have been introduced to address aggressive pathological features such as double or triple hit mutational status. Modern chemo-immunotherapy has contributed greatly to improving the survival rate and regimens consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) have become the standard of care. This benefit persists in the setting of rituximab-based systemic therapy.ĭiffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma and a majority of these patients present with stage III-IV disease. Patients receiving consolidative RT demonstrated significantly improved PFS for tumors measuring both <5 cm (log rank p = 0.0454) and ≥5 cm (log rank p = 0.0003).įor patients with stage III-IV DLBCL who achieve clinical complete response after systemic therapy, consolidative RT improves PFS for all patients, including those with the non-bulky disease. 49.2%, log rank p < 0.0001), a 14.5% absolute benefit in five-year overall survival (OS 87.4% vs. Consolidative RT conferred a 36.7% absolute benefit in five-year progression-free survival (PFS 85.9% vs. Sixty-eight patients (36%) received consolidative RT (median dose 30 Gy). Clinical response was assessed using conventional CT or PET-CT. One hundred eighty-eight patients received systemic therapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP 79%), another rituximab-based regimen (9%), or chemotherapy alone (12%). ![]() Univariate and multivariable analyses were performed using a Cox proportional hazards model. Kaplan-Meier analysis was performed to determine the impact of consolidative RT. Patients with either bulky or non-bulky disease were included, but those with the relapsed or refractory disease were excluded. Patients with treatment-naive stage III-IV DLBCL treated at two institutions who achieved a clinically complete response to systemic therapy were included. A growing body of data suggests a role for consolidative RT in select stage III-IV DLBCL patients and emerging data from randomized studies further address the role of RT in advanced-stage patients initially presenting with bulky disease. The role of consolidative radiation therapy (RT) for advanced-stage diffuse large B-cell lymphoma (DLBCL) is not fully established.
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