What is the role of radiation therapy in the treatment of early-stage DLBCL?

Updated: Jun 12, 2019
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
  • Print
Answer

The role of radiation therapy in the management of early-stage DLBCL had been challenged by 2 studies conducted by the Groupe d'Etude des Lymphomes de l'Adulte (GELA). The first study randomized patients younger than 60 years to either 3 cycles of CHOP chemotherapy followed by IF-XRT or an intense regimen consisting of doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) for 6 cycles. [83] After a median follow-up period of 7.7 years, OS and PFS were significantly better in the group given ACVBP than in the group given CHOP plus radiotherapy. The 5-year estimates of event-free survival were 82% for patients receiving chemotherapy alone and 74% for those receiving chemotherapy/radiotherapy. The respective 5-year estimates of OS were 90% and 8%. In contrast to previous clinical trials, this study included patients with bulky disease. [84]

On the other hand, the ACVBP regimen was associated with increased chemotherapy-related toxicity and a high frequency of hospitalizations. [84] Moreover, vindesine is not commercially available in the United States. Hence, chemotherapy was considered to be superior to chemo-radiotherapy.

In the second study, DLBCL patients older than 60 years with localized disease and no International Prognostic Index (IPI) factors were randomized to 4 cycles of CHOP plus IF-XRT or chemotherapy alone with 4 cycles of CHOP. After a median follow-up of 7 years, the median OS and PFS were not significantly different between the 2 treatment arms. The 5-year estimates of event-free survival were 61% for patients receiving chemotherapy alone and 64% for patients receiving CHOP plus radiotherapy; the 5-year estimates of OS were 72% and 68%, respectively. [85]

On the other hand, the Eastern Cooperative Oncology Group (ECOG) assessed the value of radiation as a consolidation after 8 cycles of standard chemotherapy in a randomized clinical trial. The study enrolled 352 patients older than 60 years with stage I or II bulky disease, who were assigned to receive CHOP chemotherapy and randomly selected to receive IF-XRT or no further treatment as consolidation in those who achieved complete response (CR). Among the 172 CR patients, the 6-year disease-free survival rate was 73% for low-dose radiotherapy versus 56% for observation. Although improvement occurred in the estimated disease-free survival after 6 years of follow up, no significant differences were noted in OS. [24]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!