PloS one · 2015
Radiotherapy Compared to Other Strategies in the Treatment of Stage I/II Follicular Lymphoma: A Study of 404 Patients with a Median Follow-Up of 15 Years.
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Barzenje Dlawer Abdulla, Cvancarova Småstuen Milada, Liestøl Knut, Fosså Alexander, Delabie Jan, Kolstad Arne, Holte Harald
Аннотация
PURPOSE: To investigate outcome for patients with follicular lymphoma (FL) stage I-II treated at a population-based referral institution with a median follow-up of 15 years. Overall and cause-specific survival was compared to that of a sex, age and residency matched individuals from normal population.
MATERIAL AND METHODS: 404 patients with early stage FL treated between 1980 and 2005 were retrospectively analyzed. Two of three patients had stage I disease. Based on clinical characteristics, first line treatments were radiotherapy (RT) (48% of patients), chemotherapy (CT) (16%), combined chemo-and radiotherapy (CRT) (16%) or observation (OBS) (15%). Survival was modeled with Kaplan-Meier methodology. Multivariate analyses were performed with the Cox model.
RESULTS: Fifteen years overall survival (OS), progression free survival (PFS) and time to next treatment (TNT) were 50% (95% confidence interval [CI]: 45-55), 42% (95% CI: 36-47) and 48% (95% CI, 42-54), respectively. For patients treated with RT 97% achieved a complete remission, and 15 year OS, PFS and TNT were 57% (95% CI, 50-64), 46% (95% CI, 39-54) and 49% (95% CI, 42-57), respectively. Relapse rate after RT and CRT was 49% and 36%, respectively. Only 2% of patients who received RT or CRT relapsed inside the radiation field and 5% had isolated near-field relapse. No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer. Compared to a matched normal population, non-lymphoma cancer mortality was higher among patients given RT, hazard ratio 1.66 (95% CI: 1.14-2.42; P<0.01). Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.
CONCLUSIONS: A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients. OBS is a valid initial choice for selected patients without lymphoma-related symptoms.
MATERIAL AND METHODS: 404 patients with early stage FL treated between 1980 and 2005 were retrospectively analyzed. Two of three patients had stage I disease. Based on clinical characteristics, first line treatments were radiotherapy (RT) (48% of patients), chemotherapy (CT) (16%), combined chemo-and radiotherapy (CRT) (16%) or observation (OBS) (15%). Survival was modeled with Kaplan-Meier methodology. Multivariate analyses were performed with the Cox model.
RESULTS: Fifteen years overall survival (OS), progression free survival (PFS) and time to next treatment (TNT) were 50% (95% confidence interval [CI]: 45-55), 42% (95% CI: 36-47) and 48% (95% CI, 42-54), respectively. For patients treated with RT 97% achieved a complete remission, and 15 year OS, PFS and TNT were 57% (95% CI, 50-64), 46% (95% CI, 39-54) and 49% (95% CI, 42-57), respectively. Relapse rate after RT and CRT was 49% and 36%, respectively. Only 2% of patients who received RT or CRT relapsed inside the radiation field and 5% had isolated near-field relapse. No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer. Compared to a matched normal population, non-lymphoma cancer mortality was higher among patients given RT, hazard ratio 1.66 (95% CI: 1.14-2.42; P<0.01). Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.
CONCLUSIONS: A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients. OBS is a valid initial choice for selected patients without lymphoma-related symptoms.
Предметные рубрики MeSH
AdolescentAdultAgedAged, 80 and overAntineoplastic Combined Chemotherapy ProtocolsCardiovascular DiseasesChemoradiotherapyChlorambucilCyclophosphamideDisease-Free SurvivalDoxorubicinFemaleFollow-Up StudiesHumansKaplan-Meier EstimateLymphoma, FollicularMaleMiddle AgedNeoplasm StagingNeoplasms, Second PrimaryNorwayPrednisoloneRegistriesRituximabTreatment OutcomeVincristineWatchful WaitingYoung Adult