| |
著者: Thierry Lamy, Gandhi Damaj, Pierre Soubeyran, Emmanuel Gyan, Guillaume Cartron, Krimo Bouabdallah, Rémy Gressin, Jérôme Cornillon, Anne Banos, Katell Le Du, Mohamed Benchalal, Marie-Pierre Moles, Steven Le Gouill, Joel Fleury, Pascal Godmer, Hervé Maisonneuve, Eric Deconinck, Roch Houot, Kamel Laribi, Jean Pierre Marolleau, Olivier Tournilhac, Bernard Branger, Anne Devillers, Jean Philippe Vuillez, Thierry Fest, Philippe Colombat, Valérie Costes, Vanessa Szablewski, Marie C Béné, Vincent Delwail, LYSA Group
雑誌名: Blood. 2018 Jan 11;131(2):174-181. doi: 10.1182/blood-2017-07-793984. Epub 2017 Oct 23.
Abstract/Text
The benefit of radiotherapy (RT) after chemotherapy in limited-stage diffuse large B-cell lymphoma (DLBCL) remains controversial. We conducted a randomized trial in patients with nonbulky limited-stage DLBCL to evaluate the benefit of RT after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Patients were stratified according to the modified International Prognostic Index, including lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, age, and disease stage. The patients received 4 or 6 consecutive cycles of R-CHOP delivered once every 2 weeks, followed or not by RT at 40 Gy delivered 4 weeks after the last R-CHOP cycle. All patients were evaluated by fluorodeoxyglucose-positron emission tomography scans performed at baseline, after 4 cycles of R-CHOP, and at the end of treatment. The primary objective of the trial was event-free survival (EFS) from randomization. The trial randomly assigned 165 patients in the R-CHOP arm and 169 in the R-CHOP plus RT arm. In an intent-to-treat analysis with a median follow-up of 64 months, 5-year EFS was not statistically significantly different between the 2 arms, with 89% ± 2.9% in the R-CHOP arm vs 92% ± 2.4% in the R-CHOP plus RT arm (hazard ratio, 0.61; 95% confidence interval [CI], 0.3-1.2; P = .18). Overall survival was also not different at 92% (95% CI, 89.5%-94.5%) for patients assigned to R-CHOP alone and 96% (95% CI, 94.3%-97.7%) for those assigned to R-CHOP plus RT (P = not significant). R-CHOP alone is not inferior to R-CHOP followed by RT in patients with nonbulky limited-stage DLBCL. This trial was registered at www.clinicaltrials.gov as #NCT00841945.
© 2018 by The American Society of Hematology.
PMID 29061568 Blood. 2018 Jan 11;131(2):174-181. doi: 10.1182/blood-2017-07-793984. Epub 2017 Oct 23.
|
