Radiation therapy after a partial response to CHOP chemotherapy for aggressive lymphomas.

Abstract

PURPOSE:

To analyze the results with involved-field radiotherapy after aggressive lymphomas had decreased in size by 50-99% in response to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy.

METHODS AND MATERIALS:

From 1988 through 1996, 294 previously untreated patients with Working Formulation intermediate-grade or large-cell immunoblastic lymphomas underwent CHOP-based chemotherapy on 2 consecutive protocols at the M. D. Anderson Cancer Center. Forty-four (15%) of these patients achieved, based on international working group guidelines, a partial (50-75%) response (n = 25), or unconfirmed complete (76-99%) response (n = 19) to a median of 6 cycles of chemotherapy. These patients were treated with salvage involved-field radiotherapy (n = 32) or chemotherapy (n = 12), e.g., MINE-ESHAP, without autologous stem-cell rescue (ASCR).

RESULTS:

Median follow-up was 43 months. Partial responders experienced similar outcomes to unconfirmed complete responders. Local control (4-year rates: 86% vs. 53%, p = 0.009) and progression-free survival (4-year rates: 67% vs. 8%, p < 0.0001), but not overall survival (4-year rates: 70% vs. 50%, p = 0.067) were significantly better in those who received salvage radiotherapy, which was well tolerated.

CONCLUSION:

Progression-free and overall survival in aggressive lymphoma patients who underwent salvage radiotherapy were similar to results reported for high-dose chemotherapy with ASCR. The role of salvage radiotherapy in partial and unconfirmed complete responders to CHOP chemotherapy justifies examination in a large, cooperative group trial.

• Authors: R B Wilder, M A Rodriguez, S L Tucker, C S Ha, M A Hess, F F Cabanillas, J D Cox
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 50 Issue 3 Pg. 743-9 (Jul 01 2001) ISSN: 0360-3016 [Print] United States
• PMID: 11395243 (Publication Type: Clinical Trial, Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Cytarabine
• Methylprednisolone Hemisuccinate
• Vincristine
• Etoposide
• Doxorubicin
• Cyclophosphamide
• Mitoxantrone
• Mesna
• Cisplatin
• Ifosfamide
• Prednisone

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Cisplatin (administration & dosage)
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage)
• Cytarabine (administration & dosage)
• Disease-Free Survival
• Doxorubicin (administration & dosage)
• Etoposide (administration & dosage)
• Humans
• Ifosfamide (administration & dosage)
• Lymphoma, Large-Cell, Immunoblastic (drug therapy, radiotherapy)
• Lymphoma, Non-Hodgkin (drug therapy, radiotherapy)
• Mesna (administration & dosage)
• Methylprednisolone Hemisuccinate (administration & dosage)
• Middle Aged
• Mitoxantrone (administration & dosage)
• Prednisone (administration & dosage)
• Retrospective Studies
• Salvage Therapy
• Vincristine (administration & dosage)