Journal of Clinical Oncology, Vol 11, 720-725, Copyright © 1993 by American Society of Clinical Oncology

ARTICLES

Combined modality treatment with primary CHOP chemotherapy followed by locoregional irradiation in stage I or II histologically aggressive non- Hodgkin's lymphomas

C Tondini, M Zanini, F Lombardi, C Bengala, A Rocca, R Giardini, R Buzzoni, P Valagussa and G Bonadonna
Division of Medical Oncology, Istituto Nazionale dei Tumori, Milano, Italy.

PURPOSE: A single-center, prospective, nonrandomized trial was conducted to evaluate therapeutic results of a short-term program of chemotherapy followed by locoregional radiotherapy in stage I or II intermediate/aggressive non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: From 1985 to 1990, 183 consecutive patients with a diagnosis of NHL (Working Formulation [WF] E through J excluding Burkitt's type), Ann Arbor stage I or II, and no more than three sites of disease involvement were treated with four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy (six cycles in partial responders). Radiation therapy to initial sites of disease involvement (40 to 44 Gy) and to proximal uninvolved nodal region (36 Gy) was delivered shortly after completion of the chemotherapy program. RESULTS: The complete remission (CR) rate was 98% at the end of combined therapy. Diagnostic excision of all measurable disease was performed in 33% of patients. In the remaining patients, 87% achieved CR with chemotherapy and 11% with radiation therapy, while three patients failed to achieve CR. After a median follow-up of 51 months, 26 patients have relapsed and 25 have died. The 5-year relapse- free and total survival rates were 83%. Aside from age older than 60 years, no other factor such as histology, stage, extranodal disease, bulky lymphoma, or abnormal lactic dehydrogenase (LDH) could predict for treatment outcome. There was a trend toward higher relapse rate for patients achieving CR at the time of radiation therapy (31%) as opposed to patients achieving CR with chemotherapy (15%) or with initial surgery (10%). Treatment was well tolerated and no deaths due to acute toxicity were observed. CONCLUSION: For patients who present with limited-stage, aggressive NHL, a short course of CHOP chemotherapy followed by locoregional irradiation is safe, highly effective, and curative for most. Therefore, at the present time this approach can be regarded as standard therapy for these patients.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				Y.-X. Li, B. Yao, J. Jin, W.-H. Wang, Y.-P. Liu, Y.-W. Song, S.-L. Wang, X.-F. Liu, L.-Q. Zhou, X.-H. He, et al. Radiotherapy As Primary Treatment for Stage IE and IIE Nasal Natural Killer/T-Cell Lymphoma J. Clin. Oncol., January 1, 2006; 24(1): 181 - 189. [Abstract] [Full Text] [PDF]

				S. Pruthi, V. K. Stafyla, S. W. Phillips, L. F. Porrata, and C. A. Reynolds Primary Mammary (Non-Hodgkin) Lymphoma Presenting as Locally Advanced Breast Cancer Mayo Clin. Proc., October 1, 2004; 79(10): 1310 - 1314. [Abstract] [PDF]

				S. J. Horning, E. Weller, K. Kim, J. D. Earle, M. J. O'Connell, T. M. Habermann, and J. H. Glick Chemotherapy With or Without Radiotherapy in Limited-Stage Diffuse Aggressive Non-Hodgkin's Lymphoma: Eastern Cooperative Oncology Group Study 1484 J. Clin. Oncol., August 1, 2004; 22(15): 3032 - 3038. [Abstract] [Full Text] [PDF]

				A. Krishnan, A. Shirkhoda, J. Tehranzadeh, A. R. Armin, R. Irwin, and K. Les Primary Bone Lymphoma: Radiographic-MR Imaging Correlation RadioGraphics, November 1, 2003; 23(6): 1371 - 1383. [Abstract] [Full Text] [PDF]

				H. A. Leitch, R. D. Gascoyne, M. Chhanabhai, N. J. Voss, R. Klasa, and J. M. Connors Limited-stage mantle-cell lymphoma Ann. Onc., October 1, 2003; 14(10): 1555 - 1561. [Abstract] [Full Text] [PDF]

				T. N. Shenkier, N. Voss, R. Fairey, R. D. Gascoyne, P. Hoskins, R. Klasa, P. Klimo, S. E. O'Reilly, S. Sutcliffe, and J. M. Connors Brief Chemotherapy and Involved-Region Irradiation for Limited-Stage Diffuse Large-Cell Lymphoma: An 18-Year Experience From the British Columbia Cancer Agency J. Clin. Oncol., January 1, 2002; 20(1): 197 - 204. [Abstract] [Full Text] [PDF]

				A. Moreno, G. Colon-Otero, and L. A. Solberg Jr. The Prednisone Dosage in the CHOP Chemotherapy Regimen for Non-Hodgkin's Lymphomas (NHL): Is There a Standard? Oncologist, June 1, 2000; 5(3): 238 - 249. [Abstract] [Full Text]

				B. P. O'Neill, C.-H. Wang, J. R. O'Fallon, J. P. Colgan, J. D. Earle, R. L. Krigel, L. D. Brown, and W. J. McGinnis The consequences of treatment and disease in patients with primary CNS non-Hodgkin's lymphoma: Cognitive function and performance status Neuro-oncol, July 1, 1999; 1(3): 196 - 203. [Abstract] [PDF]