MDACC R-CHOP + RT Limited Stage DLBCL (Phan)

Background

Retrospective single-institution series from MD Anderson Cancer Center (MDACC). 469 patients with limited-stage (stage I–II) diffuse large B-cell lymphoma (DLBCL) treated in the rituximab era with R-CHOP × 3–4 cycles + IFRT 30–40 Gy. Evaluated outcomes of CMT for limited-stage DLBCL in the rituximab era and identified prognostic factors for outcome.

Interventions and follow up

Arm A: R-CHOP × 3–4 cycles + IFRT 30–40 Gy (n=469)
Arm B: N/A (retrospective single-arm series)
Primary endpoint: Overall survival and failure-free survival
mFollow up: 5.2 year

Results

5-yr OS: 91%
5-yr FFS: 83%
5-yr OS (IPI = 0): 98%
5-yr OS (IPI ≥1): 82–88%
Local recurrence rate: <5%

Adverse events

Main adverse events: Acute RT toxicities generally mild to moderate; field-dependent (mediastinal RT: esophagitis, pulmonary effects; abdominal: GI toxicity). No significant late-toxicity analysis reported in this paper.

Conclusions

CMT with R-CHOP + IFRT achieves excellent outcomes for limited-stage DLBCL in the rituximab era, with 5-yr OS of 91%. Local recurrence is rare with consolidation IFRT, supporting the role of RT in limited-stage DLBCL after abbreviated R-CHOP.

Key Limitations

Key Limitations: Retrospective single-institution analysis — selection bias likely. No comparison arm (R-CHOP alone). The benefit of RT over R-CHOP × 6 alone for non-bulky limited-stage DLBCL is not well established in randomized data. Lamy Blood 2018 (prospective) found no benefit of RT in non-bulky limited-stage DLBCL with R-CHOP.

Clinical Context

The MDACC series was widely cited to support CMT in limited-stage DLBCL. However, the Lamy Blood 2018 (GELA 2003-22C) randomized trial subsequently showed no benefit of consolidation RT for non-bulky limited-stage DLBCL after complete metabolic response to R-CHOP. Current practice reserves consolidation RT for bulky (≥7.5 cm) disease or partial response to chemo.

References

References: Phan J et al, JCO 2010 (MDACC R-CHOP + RT)