大块复发/难治性大B细胞淋巴瘤的放疗剂量反应。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology Pub Date : 2024-09-01 DOI:10.1016/j.prro.2024.06.003

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引用次数: 0

摘要

目的：评估放疗（RT）剂量是否会影响复发/难治（r/r）弥漫大B细胞淋巴瘤（DLBCL）巨大肿瘤的反应：方法：研究了在一家机构接受挽救性或姑息性RT治疗的r/r DLBCL患者的数据（2008-2020年）。指标病灶大小≥7.5厘米定义为大块病灶。计算了2格雷（Gy）分次的等效剂量（EQD2），以比较常规和低分次（HF，≥2.5 Gy/分次）方案的剂量。客观反应率（ORR）的比较采用非参数 Mann-Whitney U 检验或 Kruskal-Wallis 检验，并进行 Dunn's 多重比较校正。采用 Kaplan-Meier 和 Cox 比例危险回归分析评估局部进展自由度（FFLP）：结果：共纳入了 151 名患者的 183 个疗程（挽救性疗程：37%，姑息性疗程：63%）。109个疗程（60%）和74个疗程（40%）分别对非肿块和肿块肿瘤进行了照射。EQD2中位数为33 Gy（IQR=23-39 Gy），其中84例（46%）为高频。在进行 RT 后成像的病例中（80%），ORR 为 59%，体积大的肿瘤的 ORR 有恶化趋势（50% 对 65%，P=0.077）。对于体积较大的肿瘤，EQD2大于30 Gy的RT方案与较好的ORR相关（≤30 Gy vs. >30 Gy：27% vs. 64%，p=0.0073），而对于非体积较大的肿瘤，较低的EQD2临界值就足够了（≤20 Gy vs. >20 Gy：38% vs. 75%，p=0.0011）。在多变量回归中，体积大的肿瘤与FFLP恶化相关（HR=2.07，95% CI=1.16-3.68，p=0.014），而EQD2>30 Gy的高EQD2与FFLP改善相关（HR=0.48，95% CI=0.25-0.93，p=0.031）。EQD2≤30Gy治疗的大块肿瘤的中位FFLP最低（4.0个月），而EQD2>30Gy的中位FFLP未达到（P=0.0047）：结论：大体积r/r DLBCL肿瘤与挽救和姑息治疗中较低的肿瘤控制结果有关。如果希望对体积较大的肿瘤进行持久的局部控制，应考虑采用EQD2较高（>30 Gy）的RT方案。

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Radiation Therapy Dose Response in Bulky Relapsed/Refractory Large B-Cell Lymphoma

Purpose

To assess whether a radiation therapy (RT) dose affects response in bulky tumors in relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL).

Methods and Materials

Data from patients with r/r DLBCL treated with salvage- or palliative-intent RT (2008-2020) at a single institution were examined. Index lesion size ≥7.5 cm was defined as bulky. Equivalent doses in 2-Gy fractions (EQD2) were calculated to compare doses between conventional and hypofractionated (≥2.5 Gy/fraction) schemes. Objective response rates (ORRs) were compared using nonparametric Mann-Whitney U test or Kruskal-Wallis test with Dunn's multiple comparison corrections. Freedom from local progression (FFLP) was assessed using Kaplan-Meier and Cox proportional hazard regression analyses.

Results

One hundred eighty-three courses of 151 unique patients were included (salvage: 37% and palliative: 63%). Nonbulky and bulky tumors were irradiated in 109 (60%) and 74 (40%) courses, respectively. Median EQD2 was 33 Gy (IQR, 23-39 Gy) with hypofractionation in 84 (46%) cases. Of those with post-RT imaging (80%), the ORR was 59%, with a trend toward worsened ORR in bulky tumors (50% vs 65%, P = .077). For bulky tumors, RT regimens with EQD2s >30 Gy were associated with better ORR (≤30 Gy vs >30 Gy: 27% vs 64%, P = .0073), whereas a lower EQD2 cutoff was sufficient for nonbulky tumors (≤20 Gy vs >20 Gy: 38% vs 75%, P = .0011). On multivariable regression analysis, bulky tumor size was associated with worsened FFLP (hazard ratio, 2.07; 95% CI, 1.16-3.68; P = .014), whereas high EQD2s >30 Gy were associated with better FFLP (hazard ratio, 0.48; 95% CI, 0.25-0.93; P = .031). Bulky tumors treated with EQD2s ≤30 Gy had the lowest median FFLP (4.0 months), whereas EQD2s >30 Gy had an unreached median FFLP (P = .0047).

Conclusions

Bulky r/r DLBCL tumors were associated with less favorable tumor control outcomes in the salvage and palliative settings. RT regimens with higher EQD2s (>30 Gy) should be considered if durable local control of bulky tumors is desired.

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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.