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Published on: February 12, 2017
Interim Positron Emission Tomography-Guided Dose-Adapted Residual Site Radiation Therapy Improves Survival in Diffuse
Jie Zhao1, Fang Huang1, Rui Liu1
1Department of Hematology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Purpose:
Optimal management of diffuse large B-cell lymphoma (DLBCL) patients achieving partial remission (Deauville 5-point scale [5PS]: 4-5) with interim positron emission tomography (iPET) is undefined. This study evaluated iPET-guided, dose-adapted residual site radiation therapy (RSRT) outcomes.
Methods And Materials:
Retrospective analysis of 68 DLBCL patients with iPET 5-PS 4 to 5 after 4 Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP) cycles was conducted. Twenty-nine patients received 2 additional R-CHOP + risk-adapted RSRT (24 Gy for 5-PS4; 40 Gy for 5-PS5), while 39 received 2 to 4 R-CHOP cycles without radiation therapy (RT).
Results:
The RT cohort demonstrated significantly higher end-of-treatment complete response rates (72.4% vs 38.5%; P = .006) and superior progression-free survival (PFS) (2-year, 85.8% vs 52.9%; 5-year, 57.2% vs 44.1%; log-rank P = .025). No overall survival difference was observed (0 deaths in RT vs non-RT cohort; 2- and 5-year overall survival rates of 88.1% and 77.3%, respectively; P = .068). Multivariate analysis confirmed RT as an independent protective factor (hazard ratio, 0.26; 95% CI, 0.09-0.79; P = .018). Subgroup analysis revealed consistent PFS benefits across high-risk features, including advanced stage, high International Prognostic Index, and BCL2+ disease. RT-related toxicities were manageable (grade 4 gastrointestinal perforation, n = 1; grade 2 pneumonitis, n = 2).
Conclusions:
iPET-guided dose-adapted RSRT significantly enhances tumor response and PFS in DLBCL patients with suboptimal interim metabolic response, demonstrating favorable safety. This represents a promising strategy for high-risk partial metabolic responders, warranting prospective validation.
