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Definitive radiotherapy for localized follicular lymphoma staged by 18F-FDG PET-CT: a collaborative study by ILROG

 Jessica L. Brady  ;  Michael S. Binkley  ;  Carla Hajj  ;  Monica Chelius  ;  Karen Chau  ;  Alex Balogh  ;  Mario Levis  ;  Andrea Riccardo Filippi  ;  Michael Jones  ;  Michael Mac Manus  ;  Andrew Wirth  ;  Masahiko Oguchi  ;  Anders Krog Vistisen  ;  Therese Youssef Andraos  ;  Andrea K. Ng  ;  Berthe M. P. Aleman  ;  Seo Hee Choi  ;  Youlia Kirova  ;  Sara Hardy  ;  Gabriele Reinartz  ;  Hans T. Eich  ;  Scott V. Bratman  ;  Louis S. Constine  ;  Chang-Ok Suh  ;  Bouthaina Dabaja  ;  Tarec C. El-Galaly  ;  David C. Hodgson  ;  Umberto Ricardi  ;  Joachim Yahalom  ;  Richard T. Hoppe  ;  N. George Mikhaeel 
 Blood, Vol.133(3) : 237-245, 2019 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Female ; Fluorodeoxyglucose F18* ; Follow-Up Studies ; Humans ; Lymphoma, Follicular/diagnostic imaging ; Lymphoma, Follicular/pathology* ; Lymphoma, Follicular/radiotherapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/diagnostic imaging ; Neoplasm Recurrence, Local/pathology* ; Neoplasm Recurrence, Local/radiotherapy ; Positron Emission Tomography Computed Tomography/standards* ; Prognosis ; Radiopharmaceuticals* ; Radiotherapy/mortality* ; Retrospective Studies ; Survival Rate ; Young Adult
Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50%. As 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60% of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ≥24 Gy, staged by PET-CT, age ≥18 years, and follow-up ≥3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1%) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9% and 95.7%. For stage I, FFP was 74.1% vs 49.1% for stage II (P < .0001). Eight patients relapsed in-field (1.6%). Four had marginal recurrences (0.8%) resulting in local control rate of 97.6%. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95% CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Suh, Chang Ok(서창옥)
Choi, Seo Hee(최서희) ORCID logo https://orcid.org/0000-0002-4083-6414
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