This article is more than 5 years old. Information may no longer be current.
Chemotherapy after involved-field radiotherapy improves PFS for follicular lymphoma
Click Here to Manage Email Alerts
The addition of systemic therapy to involved-field radiotherapy reduced relapse and improved PFS among patients with early-stage follicular lymphoma, according to results from a randomized controlled trial.
“Patients should be aware that there is now high-level evidence in support of combined-modality therapy in early-stage follicular lymphoma,” Michael MacManus, MBBCh, from the department of radiation oncology at Peter MacCallum Cancer Centre in Melbourne, Australia, told HemOnc Today. “Patients who have undergone PET staging and who receive both radiotherapy and rituximab-containing immunochemotherapy can expect a high chance of long-term disease control and excellent long-term survival with a very low risk for long-term complications of therapy.”
Studies have shown combined treatment modalities with sequential chemotherapy and radiotherapy can lead to positive outcomes among patients with early-stage Hodgkin lymphoma and aggressive lymphomas, but it has not been explored as an option for localized follicular lymphoma.
Researchers from the Trans-Tasman Radiation Oncology Group, the Australasian Leukemia and Lymphoma Group and Princess Margaret Hospital in Toronto, Canada, collaborated to determine whether the addition of systemic therapy to involved-field radiotherapy would improve long-term PFS.
Investigators randomly assigned 150 patients (median age, 57 years; 52% men; 75% stage I disease; 48% PET staged) to receive 30-Gy involved-field radiotherapy (n = 75) or 30-Gy involved-field radiotherapy followed by six cycles of chemotherapy — cyclophosphamide, vincristine and prednisolone — 4 weeks after radiotherapy ended (n = 75).
Among those who received systemic therapy, 44 patients received chemotherapy alone and 31 also received rituximab (Rituxan; Genentech, Biogen).
PFS served as the primary endpoint.
The median potential follow-up time was 9.6 years (range, 3.1-15.8).
After adjustment for minimization variables, disease stage, PET and older age, patients who received involved-field radiotherapy with systemic therapy had superior PFS than patients who received involved-field radiotherapy alone (HR = 0.57; 95% CI, 0.33-0.95). This effect appeared especially pronounced among patients who also received rituximab (adjusted HR = 0.26; 95% CI, 0.07-0.97).
Fifty-nine percent (95% CI, 46-74) of patients who underwent involved-field radiotherapy plus systemic therapy achieved 10-year PFS compared with 41% (95% CI, 30-57) of patients who received involved-field radiotherapy alone.
None of the patients treated with rituximab with follow-up longer than 3.5 years experienced relapse.
Univariable analysis indicated fewer sites of nodal involvement (P = .047) and extranodal involvement (P = .02) as biologic factors associated with superior PFS.
PET staging also was associated with superior PFS (HR = 0.61; P = .056).
By last follow-up, 14 patients experienced progression to aggressive lymphoma, including 10 patients who received involved-field radiotherapy alone and four received radiotherapy plus systemic therapy.
Researchers did not observe a significant difference in OS at 10 years among the groups (87% vs. 95%).
Longer follow-up is still needed to estimate the long-term survival benefit due to the natural history of the disease and longer intervals between relapse and mortality, according to MacManus.
“The excellent long-term OS for patients treated with radiotherapy alone in our series is probably due the improved effectiveness of modern salvage therapies compared to historical series,” MacManus said.
Still, he added, “When treatment decisions are being made for patients with early-stage disease, patients and their physicians should be aware that the only successfully completed randomized trial in early-stage follicular lymphoma comparing locally therapy alone with local therapy plus effective systemic therapy shows that disease control is far superior among patients treated with combined-modality therapy, especially when the systemic therapy includes rituximab.” – by Melinda Stevens
For more information:
Michael MacManus, MBBCh, can be reached at Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, Victoria 3000, Australia; e-mail: michael.macmanus@petermac.org.
Disclosures: MacManus reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts