3/28/2023 0 Comments Unfolder trial lymphoma![]() Several recent studies attempted to identify subgroups of patients who may benefit from RT. 19 However, these trials need to be updated in the context of more effective systemic therapy like R-CHOP. 20 Finally, the Groupe d’Etude des Lymphomes de l’Adulte LNH 93-4 trial found no difference between four cycles of CHOP with or without RT ( Tables 1- 5). 21 The Groupe d’Etude des Lymphomes de l’Adulte LNH 93-1 trial for patients age ≤ 60 years demonstrated that doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) is superior to three cycles of CHOP plus RT. The East Coast Oncology Group 1484 trial showed an improved failure-free survival in the RT arm after a CR to eight cycles of CHOP, supporting the role of RT even after a CR to a full chemotherapy course. 18- 21 The Southwest Oncology Group 8736 trial showed an initial progression-free and survival benefit of three cycles of CHOP plus RT over eight cycles of CHOP, 18 but longer follow-up showed no difference, 22 establishing that an abbreviated course of chemotherapy is comparable to a long course when RT is added. For early-stage aggressive NHL, four historical randomized trials, all from the pre-rituximab era, compared chemotherapy with or without RT with mixed results. No matter how effective a modality is with respect to local control, its addition will make no difference if the disease is not well controlled systemically. The Role of RT in the Pre-Rituximab Era and in Current PracticeĪlthough RT provides effective local control for DLBCL, a crucial question is whether this improvement in local control leads to disease-specific survival differences. 15, 16 General suggestions that RT no longer has a role in treating early-stage lymphomas should thus be reexamined carefully. These findings echo the results of several single-institutional series, 7- 11 large database analyses, 12 and subgroup analyses of prospective trials, 13, 14 as well as preliminary findings of prospective clinical trials supporting the role of RT in selected patients with DLBCL treated in the modern era. In a recent study published in Journal of Clinical Oncology, 1 the authors focused on stages I and II DLBCL, showing that the receipt of RT is associated with a 34% reduction in mortality on multivariable analysis with propensity score adjustment. In addition, reduced odds of receiving RT in patients with lower socioeconomic status were found, raising concerns regarding access and health equity. These studies also reported on pattern of RT use over time, 1- 6 each demonstrating decreasing trends in RT use in recent years. Several recent studies using data from the National Cancer Data Base demonstrated inferior survival for patients not receiving RT, although comparing treatment outcomes using these data is limited by the inability to control for unobserved confounders. ![]() The curative treatment of the common early-stage lymphomas such as diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL) has traditionally been with combined-modality therapy (CMT) using abbreviated chemotherapy followed by consolidation radiation therapy (RT). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |