Researchers from Germany have reported that elderly patients with aggressive non-Hodgkin’s lymphoma (NHL) with bulky disease who achieve a partial response (PR) after chemotherapy may benefit from local radiotherapy. The details of this study were presented at the 2009 meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO) in the first week of November.[1]
The standard treatment for patients with diffuse large B-cell lymphoma (DLBCL) is six cycles of Rituxan® (rituximab) and CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) given every 14 days (R-CHOP-14). The role of local radiotherapy to sites of bulky disease is controversial. Researchers involved in the current study reported data on two consecutive clinical trials. In the first trial, 117 patients with bulky DLBCL received radiotherapy to sites of bulky disease after remission induction with R-CHOP-14. In the second trial, 114 patients received R-CHOP-14 and no radiotherapy. The complete response rates were 76% and 78%, respectively. The following table summarizes the outcomes of these two trials in patients with bulky disease.
Table 1: R-CHOP-14 + RT Versus R-CHOP-14 - RT
| R-CHOP-14 + RT | R-CHOP-14 - RT |
Number of patients | 117 | 114 |
18-month event-free survival | 68% | 43% (0.002) |
Progression-free survival | 77% | 67% (p=0.123) |
Overall survival | 80% | 76% (p=0.509) |
The lower event-free survival in patients in the R-CHOP-14 + RT group was due to the relatively small number of patients with bulky disease who achieved a PR after R-CHOP-14. Patients who had a CR to R-CHOP-14 did not benefit; this comprised over 75% of patients in both groups.
Comments: These data would suggest that radiotherapy to sites of bulky disease would benefit only the small fraction of patients with DLBCL who did not achieve a CR to induction therapy with R-CHOP-14.
Reference:
[1] Rube C, Ziepert M, Schmidberger H, et al. The impact of radiotherapy to bulky disease after R-CHOP chemotherapy in aggressive lymphomas: Results from two prospective trials of the German High-Grade Non-Hodgkin-Lymphoma Study Group (DSHNHL) for elderly patients with DLBCL. International Journal of Radiation Oncology Biology Physics. 2009;75:issue 3, supplement, page S63, abstract 132.
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