Originally published as JCO Early Release 10.1200/JCO.2007.15.4773 on March 10 2008

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Involved-Field Radiotherapy Before High-Dose Therapy and Autologous Stem-Cell Rescue in Diffuse Large-Cell Lymphoma: Long-Term Disease Control and Toxicity

Bradford S. Hoppe, Craig H. Moskowitz, Daniel A. Filippa, Chaya S. Moskowitz, Tarun Kewalramani, Andrew D. Zelenetz, Joachim Yahalom

From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY

Corresponding author: Joachim Yahalom, MD, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10165; e-mail: yahalomj{at}mskcc.org

Purpose To analyze outcome, prognostic factors, and toxicities in patients with diffuse large-cell lymphoma (DLCL) who received involved-field radiotherapy (IFRT) before high-dose chemotherapy with autologous stem-cell rescue (ASCR).

Patients and Methods Between January 1990 and August 2006, 164 patients with relapsed or refractory DLCL received IFRT at Memorial Sloan-Kettering Cancer Center (New York, NY) before high-dose chemotherapy and ASCR. IFRT was delivered to involved sites measuring more than 5 cm or to sites with residual disease more than 2 cm. Radiotherapy was administered in 1.5-Gy fractions twice daily to a total dose of 30 Gy. Progression-free survival and overall survival were calculated, and short- and long-term toxicity was assessed according to National Cancer Institute Common Toxicity Criteria (version 2.0). Median follow-up was 60 months (range, 2 to 187 months).

Results Two- and 5-year progression-free survival was 62% and 53%; 2- and 5-year overall survival was 67% and 58%, respectively. Sixty-seven patients relapsed; only 10 patients relapsed completely within the radiotherapy field. There were seven early treatment-related mortalities and 11 secondary cancers (including four myelodysplastic syndromes), one of which occurred within the IFRT site and five after total-body irradiation.

Conclusion Minimal treatment-related mortality and morbidity resulted from short, intensive, involved-field radiotherapy before high-dose chemotherapy and ASCR, which was incorporated into a salvage regimen for patients with relapsed/refractory DLCL. This chemoradiotherapy salvage regimen resulted in a low local relapse rate that could potentially translate into an improved total outcome.

published online ahead of print at www.jco.org on March 10, 2008.

Supported by the Lymphoma Foundation and the Sports Foundation against Cancer.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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