接受R-CHOP 治疗的弥漫大B细胞性淋巴瘤患者可从巩固性放疗中获益

 

MD Anderson癌症中心

全球肿瘤快讯 摘自：J Clin Oncol. 2010 Sep 20;28(27):4170-6.

背景：目前，弥漫大B 细胞性淋巴瘤（DLBCL）的标准治疗方案为利妥昔单抗联合CHOP 方案化疗（R-CHOP）。巩固性放疗在R-CHOP 化疗后DLBCL 患者中的作用尚无完善的报道。这项回顾性分析旨在阐明巩固性放疗的作用。武汉协和医院肿瘤中心刘红利

病人与方法：研究共入组了2001 年1月至2007年12月的469 例接受治疗的弥漫大B 细胞性淋巴瘤患者。研究变量包括年龄、性别、Ann Arbor疾病分期、巨块型疾病状态、PET检查的标准化摄取值（SUVs）、国际预后指数（IPI）以及Ki-67染色（增殖）。

结果：469 例患者中，190 例（40.5%）为I或II期，279 例（59.5%）为III或IV期；327例（70%）患者接受了至少6个疗程的R-CHOP 方案化疗，142 例（30.2%）患者化疗获得完全缓解（CR）后接受了受累野放疗（剂量，30~39.6 Gy）。中位随访期36个月（范围，8~85个月）。多变量分析显示，放疗（P<0.0001）、IPI评分（P=0.001）、疗效（P=0.001）、采用6~8个疗程R-CHOP方案（P<0.001）以及伴（P=0.006）或不伴（P=0.025）高Ki-67、高PET SUV、巨块型肿瘤可影响患者的总生存（OS）和无进展生存（PFS）。对接受6~8 个疗程RCHOP方案治疗的I或II期患者（44对）和所有期患者（74对）进行配对分析，结果提示，与未接受放疗相比，放疗可改善总生存（HR分别为0.52和0.29）和无进展生存（HR分别为0.45和0.24）。

结论：弥漫大B 细胞性淋巴瘤患者R-CHOP 化疗后接受巩固性放疗可显著改善总生存和无进展生存。

Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy.

The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

J Clin Oncol. 2010 Sep 20;28(27):4170-6.

Abstract
PURPOSE: The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The role of consolidative radiation therapy (RT) in the setting of R-CHOP chemotherapy is not well reported. This retrospective analysis is an attempt to clarify this role.

PATIENTS AND METHODS: Subjects were 469 patients with histologically confirmed DLBCL treated between January 2001 and December 2007. Variables including age, sex, Ann Arbor disease stage, bulky disease status, standardized uptake values (SUVs) on positron emission tomography (PET), International Prognostic Index (IPI), and Ki67 staining (proliferation).

RESULTS: Of 469 patients, 190 (40.5%) had stage I or II disease and 279 (59.5%) had stage III or IV disease, 327 (70%) had at least six cycles of R-CHOP, and 142 (30.2%) had involved-field RT (dose, 30 to 39.6 Gy) after complete response to chemotherapy. Median follow-up was 36 months (range, 8 to 85 months). Multivariate analysis showed that RT (P < .0001), IPI score (P = .001), response to therapy (P = .001), use of six to eight cycles of R-CHOP (P < .001), and combined presence (P = .006) or absence (P = .025) of high Ki67, high PET SUV, and bulky disease influenced overall survival (OS) and progression-free survival (PFS). Matched-pair analyses of patients who received six to eight cycles of R-CHOP with stage I or II disease (44 pairs) and all stages (74 pairs) indicated that RT improved OS (hazard ratio [HR], 0.52 and 0.29, respectively) and PFS (HR, 0.45 and 0.24, respectively) compared with no RT.

CONCLUSION: This study showed significant improvements in OS and PFS among patients who received consolidation RT after R-CHOP chemotherapy for DLBCL.

PMID: 20713859