Consolidative radiotherapy use after multi-agent chemotherapy for treatment of diffuse large B-cell lymphoma (DLBCL) has decreased in recent years, according to a recent study published online ahead of print in the Journal of Clinical Oncology.
In addition, selection of consolidative radiotherapy with chemotherapy as opposed to chemotherapy alone is affected by socioeconomic factors and classical prognostic features.
John Vargo, MD, and fellow researchers at the University of Pittsburgh looked through the National Cancer Data Base and identified 59,255 patients with stages I and II DLBCL who were treated with either multi-agent chemotherapy alone chemotherapy plus consolidative radiotherapy from 1998 to 2012.
Among these patients, 46 percent had stage II disease and 42 percent had extranodal disease. Fifty-eight percent were more than 60 years of age.
They found that only 39 percent of patients received the combined-modality therapy, and this proportion significantly declined from 47 percent in 2000 to 32 percent in 2012. Selection of treatment was significantly influenced by factors such as race, comorbidity, insurance type, education quartile, age, and distance from treatment facitlity.
When estimating for five- and 10-year overall survival rates, they were found to be, respectively, 79 percent and 59 percent for all patients, 75 percent and 55 percent for patients receiving chemotherapy alone, and 82 percent and 64 percent for those receiving the combined therapy.
After adjusting for immortal times and indication bias, the researchers found that the combined therapy was associated with better overall survival than chemotherapy alone.
“Abandonment of combined-modality therapy in favor of chemotherapy alone negatively affects patient survival,” the authors concluded.
- Vargo JA, Gill BS, Balasubramani GK, et al. Treatment Selection and Survival Outcomes in Early-Stage Diffuse Large B-Cell Lymphoma: Do We Still Need Consolidative Radiotherapy? Journal of Clinical Oncology. doi: 10.1200/JCO.2015.61.7654. [epub ahead of print]. August 10, 2015.