NEW YORK (Reuters Health) - Radiotherapy to bulky disease improved outcomes of elderly patients with aggressive B-cell lymphoma, in the RICOVER trial.
"Give radiotherapy to bulky disease unless the patient is treated within a prospective study," Dr. Michael Pfreundschuh from Universitaetsklinikum des Saarlandes, Homburg, Germany advised in an email to Reuters Health. He would recommend this approach "until an appropriately designed prospective study will show that this is not necessary for patients with primary bulky disease which is negative on PET after the completion of immunochemotherapy (R-CHOP)."
Standard therapy for patients with aggressive B-cell lymphoma is rituximab plus CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), but the role of radiotherapy remains unclear.
Dr. Pfreundschuh and colleagues in the RICOVER trial investigated the impact of radiotherapy on outcomes of aggressive B-cell lymphoma in 164 elderly patients assigned to no radiotherapy and 306 patients who received radiotherapy.
In the overall study (including patients with and without bulky disease), there was no difference in overall response or three-year event-free survival, progression-free survival, and overall survival with vs without radiotherapy.
But when the analyses were limited to patients with bulky disease, there were fewer relapses with vs without radiation (4% vs 22%; p=0.007), the authors reported February 3rd online in the Journal of Clinical Oncology.
There was a trend for worse progression-free survival among patients with bulky disease who had no radiotherapy, and there was a trend for worse three-year overall survival in the same patients (63% versus 78% for those who had radiotherapy).
In a per-protocol analysis, three-year event-free survival was inferior in patients with bulky disease who did not receive radiotherapy (54% vs 80%). Patients with bulky disease who did not receive radiotherapy also had worse progression-free survival (62% vs 88%) and worse overall survival (65% vs 90%).
Secondary neoplasms occurred with similar frequency in the two groups, and most adverse effects resulted from chemotherapy, not radiotherapy.
"Since the radiotherapy (36 Gy) is not only effective, but also well tolerated, I see no alternative for the time being," Dr. Pfreundschuh concluded.
SOURCE: http://bit.ly/1fmUcoH
J Clin Oncol 2014.
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