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Chemoradiotherapy for Localized Non-Hodgkin's Lymphoma: Lessons From Old Studies

Marmara University Hospital, Medical Oncology Department, Istanbul, Turkey

Mert Basaran, Haluk Onat

Istanbul University, Oncology Institute, Istanbul, Turkey

To the Editor:

We read with interest the results of Eastern Cooperative Oncology Group (ECOG) study 1484, reported by Horning et al.¹ The results suggested that consolidative radiotherapy (RT) offers no additional survival benefit to eight cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) in patients with limited stage diffuse aggressive non-Hodgkin's lymphoma (NHL). It has previously been reported that three cycles of CHOP plus RT is superior to eight cycles of CHOP in terms of efficacy and toxicity in patients with early stage NHL.² Given the rate of late relapses and absence of a plateau in the survival curve with longer follow-up in the update of the Southwest Oncology Group (SWOG) trial, the question related to the benefit of longer chemotherapy (CT) plus RT in early-stage NHL might still be considered interesting.³ Thus, despite being an old study with lack of prognostic stratification of patients (according to International Prognostic Index) ECOG 1484 has shown that neither prolongation of chemotherapy nor the addition of RT to prolonged CT further improved the survival outcome. At this point, we think that it would be interesting to know of any chemotherapy-related long-term toxicity that occurred in ECOG 1484 given the study's long median follow-up duration; this toxicity could be one of the reasons why longer chemotherapy did not work. Another issue not mentioned is the subsequent treatment strategies for patients who achieved partial remission (PR). We would like to know if any salvage chemotherapy or high-dose chemotherapy or rituxumab was offered to patients who achieved PR following eight cycles of CHOP. Finally, the higher 6-year survival outcome in the patient group that had PR following eight cycles of CHOP could be due to the method of response assessment with inclusion of unconfirmed complete remissions in the PR group.⁴ Nevertheless, this study has important implications for the design of future trials, underscoring the need for incorporation of new treatment strategies to trial design and selection of more homogeneous patient subgroups. With advances in radiologic imaging (ie, PET) and in molecular oncology (ie, definition of different prognostic groups by genetic expression profiles through translational research and development of molecularly targeted agents), the future holds promise for substantial progress in management of this curable disease.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Horning SJ, Weller E, Kim K, et al: Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkin's lymphoma: Eastern Cooperative Oncology Group study 1484. J Clin Oncol 22:3032-3038, 2004[Abstract/Free Full Text]

2. Miller TP, Dahlberg S, Cassady JR, et al: Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med 339:21-26, 1998[Abstract/Free Full Text]

3. Miller TP, LeBlanc M, Spier CM, et al: CHOP alone compared to CHOP plus radiotherapy for early stage aggressive non-Hodgkin's Lymphomas: Update of the Southwestern Oncology Group (SWOG) randomized trial. Blood 98:724A, 2001 (abstr 3024)

4. Cheson BD, Horning SJ, Coiffier B, et al: Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas: NCI Sponsored International Working Group. J Clin Oncol 17:1244-1253, 1999[Abstract/Free Full Text]

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Related Reply

• In Reply:
  Sandra J. Horning
  JCO 2005 23: 3162-3163 [Full Text]

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