Intensity Modulated Radiation Therapy for Early-Stage Primary Gastric Diffuse Large B-Cell Lymphoma: Dosimetric Analysis, Clinical Outcome, and Quality of Life.

Abstract

PURPOSE:

To evaluate the dosimetric superiority, efficacy, toxicity, and quality of life (QOL) data of intensity modulated radiation therapy (IMRT) in patients with primary gastric diffuse large B-cell lymphoma (PG-DLBCL).

METHODS AND MATERIALS:

Forty-six consecutive patients with early-stage PG-DLBCL underwent IMRT after chemotherapy. The majority of patients (61.5%) were subclassified as the non-germinal center B cell-like subtype. Dosimetric parameters of the planning target volume (PTV) and organs at risk were assessed. Survival rates were depicted with the Kaplan-Meier method and compared with the log-rank test. Quality of life was evaluated using the QLQ-C30-STO22 questionnaires at the last follow-up contact.

RESULTS:

The median PTV mean dose was 41.6 Gy. Only 0.73% of the PTV received <95% of the prescribed dose, indicating excellent target coverage. The median kidney V20 and liver V30 were 14.1% and 16.1%, respectively. The 5-year overall survival (OS), progression-free survival, and locoregional control rates for all patients were 80.4%, 75.0%, and 93.2%, respectively. Stage, lactate dehydrogenase level, and immunophenotype were significant prognostic factors for OS, and only stage was a significant factor for locoregional control. Consolidation IMRT in patients with complete response after chemotherapy resulted in significantly better OS and progression-free survival than salvage IMRT in patients with non-complete response. Two of 8 patients who had chronic liver disease experienced grade 4 or grade 5 acute hepatic failure after 4 to 5 cycles of rituximab-based chemotherapy and IMRT (40 Gy). No other serious acute or late toxicity was observed. The long-term global and functional QOL scales were excellent, with negligible symptom scales.

CONCLUSIONS:

Intensity modulated radiation therapy yielded excellent target coverage and critical tissue sparing and achieved favorable outcomes with acceptable toxicity and good long-term QOL in early-stage PG-DLBCL.

• Authors: Xin Liu, Hui Fang, Yuan Tian, Wei-Hu Wang, Yong-Wen Song, Shu-Lian Wang, Yue-Ping Liu, Xiao-Hui He, Mei Dong, Hua Ren, Jing Jin, Ye-Xiong Li
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 95 Issue 2 Pg. 712-20 (06 01 2016) ISSN: 1879-355X [Electronic] United States
• PMID: 27034178 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Female
• Humans
• Lymphoma, Large B-Cell, Diffuse (mortality, pathology, psychology, radiotherapy)
• Male
• Middle Aged
• Neoplasm Staging
• Quality of Life
• Radiotherapy Dosage
• Radiotherapy, Intensity-Modulated (methods)
• Stomach Neoplasms (mortality, pathology, psychology, radiotherapy)
• Treatment Outcome