Primary diffuse large b-cell lymphoma of the tonsil: Is a higher radiotherapy dose required?
The purpose was to evaluate the prognostic factors and treatment outcome of Indian patients with primary diffuse large B-cell lymphoma (DLBCL) of the tonsil treated at a single institution. In all, 121 patients with DLBCL of the tonsil, treated at the Tata Memorial Hospital, Mumbai, India, from Janu...
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| Veröffentlicht in: | Cancer 2007-08, Vol.110 (4), p.816-823 |
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| creator | LASKAR, Siddhartha BAHL, Gaurav MUCKADEN, Mary Ann NAIR, Reena GUPTA, Sudeep BAKSHI, Ashish GUJRAL, Sumeet SHET, Tanuja SHYAM KISHORE SHRIVASTAVA KETAYUN ARDESHIR DINSHAW |
| description | The purpose was to evaluate the prognostic factors and treatment outcome of Indian patients with primary diffuse large B-cell lymphoma (DLBCL) of the tonsil treated at a single institution.
In all, 121 patients with DLBCL of the tonsil, treated at the Tata Memorial Hospital, Mumbai, India, from January 1990 to December 2002, were included. The median age was 45 years and the majority of patients (68%) were males. Systemic symptoms were present in 12% of patients; 28% presented with stage I and 67% had stage II disease. Treatment consisted of a combination of chemotherapy (CTh) and radiotherapy (RT) for the majority of patients (69.4%). Among those receiving RT, 64% received an RT dose of > or =45 Gy.
After a median follow-up of 62 months, disease-free survival (DFS) and overall survival (OS) were 66.4% and 81.6%, respectively. Significant prognostic factors included: WHO performance score > or =2 (OS: 72.1% vs 95.6%, P = .016), bulky tumors (OS: 68.5% vs 86.9%, P = .001), presence of B-symptoms (OS: 36.7% vs 79.6%, P < .001), and Ann Arbor stage. On multivariate analysis; WHO performance score > or =2 (hazard ratio [HR], 4.27; 95% confidence interval [CI], 1.20-15.12), and B symptoms (HR, 6.27; 95% CI, 2.38-16.48), retained statistical significance. CTh + RT resulted in a significantly better outcome than those treated with CTh alone (OS: 85.7% vs 70.7%, P = .008). The complete response (P = .053), DFS (P = .039), and OS (P = .014) rates were significantly better for patients receiving an RT dose > or =45 Gy.
Tumor bulk, WHO performance score, the presence of B symptoms, and Ann Arbor stage significantly influence outcome. A combined modality treatment, consisting of CTh and RT (with an RT dose of > or =45 Gy), results in a satisfactory outcome in patients with this uncommon neoplasm. |
| doi_str_mv | 10.1002/cncr.22841 |
| format | Article |
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In all, 121 patients with DLBCL of the tonsil, treated at the Tata Memorial Hospital, Mumbai, India, from January 1990 to December 2002, were included. The median age was 45 years and the majority of patients (68%) were males. Systemic symptoms were present in 12% of patients; 28% presented with stage I and 67% had stage II disease. Treatment consisted of a combination of chemotherapy (CTh) and radiotherapy (RT) for the majority of patients (69.4%). Among those receiving RT, 64% received an RT dose of > or =45 Gy.
After a median follow-up of 62 months, disease-free survival (DFS) and overall survival (OS) were 66.4% and 81.6%, respectively. Significant prognostic factors included: WHO performance score > or =2 (OS: 72.1% vs 95.6%, P = .016), bulky tumors (OS: 68.5% vs 86.9%, P = .001), presence of B-symptoms (OS: 36.7% vs 79.6%, P < .001), and Ann Arbor stage. On multivariate analysis; WHO performance score > or =2 (hazard ratio [HR], 4.27; 95% confidence interval [CI], 1.20-15.12), and B symptoms (HR, 6.27; 95% CI, 2.38-16.48), retained statistical significance. CTh + RT resulted in a significantly better outcome than those treated with CTh alone (OS: 85.7% vs 70.7%, P = .008). The complete response (P = .053), DFS (P = .039), and OS (P = .014) rates were significantly better for patients receiving an RT dose > or =45 Gy.
Tumor bulk, WHO performance score, the presence of B symptoms, and Ann Arbor stage significantly influence outcome. A combined modality treatment, consisting of CTh and RT (with an RT dose of > or =45 Gy), results in a satisfactory outcome in patients with this uncommon neoplasm.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.22841</identifier><identifier>PMID: 17582622</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>New York, NY: Wiley-Liss</publisher><subject>Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biological and medical sciences ; Child ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Hematologic and hematopoietic diseases ; Humans ; India ; Kaplan-Meier Estimate ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Lymphoma, B-Cell - drug therapy ; Lymphoma, B-Cell - pathology ; Lymphoma, B-Cell - radiotherapy ; Lymphoma, Large B-Cell, Diffuse - drug therapy ; Lymphoma, Large B-Cell, Diffuse - pathology ; Lymphoma, Large B-Cell, Diffuse - radiotherapy ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Radiotherapy Dosage ; Treatment Outcome ; Tumors</subject><ispartof>Cancer, 2007-08, Vol.110 (4), p.816-823</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c274t-e9f3d4b91177e9c43dcf8229e4c637547627dc758d6cc2bc61f54656f9029cdb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18959075$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17582622$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LASKAR, Siddhartha</creatorcontrib><creatorcontrib>BAHL, Gaurav</creatorcontrib><creatorcontrib>MUCKADEN, Mary Ann</creatorcontrib><creatorcontrib>NAIR, Reena</creatorcontrib><creatorcontrib>GUPTA, Sudeep</creatorcontrib><creatorcontrib>BAKSHI, Ashish</creatorcontrib><creatorcontrib>GUJRAL, Sumeet</creatorcontrib><creatorcontrib>SHET, Tanuja</creatorcontrib><creatorcontrib>SHYAM KISHORE SHRIVASTAVA</creatorcontrib><creatorcontrib>KETAYUN ARDESHIR DINSHAW</creatorcontrib><title>Primary diffuse large b-cell lymphoma of the tonsil: Is a higher radiotherapy dose required?</title><title>Cancer</title><addtitle>Cancer</addtitle><description>The purpose was to evaluate the prognostic factors and treatment outcome of Indian patients with primary diffuse large B-cell lymphoma (DLBCL) of the tonsil treated at a single institution.
In all, 121 patients with DLBCL of the tonsil, treated at the Tata Memorial Hospital, Mumbai, India, from January 1990 to December 2002, were included. The median age was 45 years and the majority of patients (68%) were males. Systemic symptoms were present in 12% of patients; 28% presented with stage I and 67% had stage II disease. Treatment consisted of a combination of chemotherapy (CTh) and radiotherapy (RT) for the majority of patients (69.4%). Among those receiving RT, 64% received an RT dose of > or =45 Gy.
After a median follow-up of 62 months, disease-free survival (DFS) and overall survival (OS) were 66.4% and 81.6%, respectively. Significant prognostic factors included: WHO performance score > or =2 (OS: 72.1% vs 95.6%, P = .016), bulky tumors (OS: 68.5% vs 86.9%, P = .001), presence of B-symptoms (OS: 36.7% vs 79.6%, P < .001), and Ann Arbor stage. On multivariate analysis; WHO performance score > or =2 (hazard ratio [HR], 4.27; 95% confidence interval [CI], 1.20-15.12), and B symptoms (HR, 6.27; 95% CI, 2.38-16.48), retained statistical significance. CTh + RT resulted in a significantly better outcome than those treated with CTh alone (OS: 85.7% vs 70.7%, P = .008). The complete response (P = .053), DFS (P = .039), and OS (P = .014) rates were significantly better for patients receiving an RT dose > or =45 Gy.
Tumor bulk, WHO performance score, the presence of B symptoms, and Ann Arbor stage significantly influence outcome. A combined modality treatment, consisting of CTh and RT (with an RT dose of > or =45 Gy), results in a satisfactory outcome in patients with this uncommon neoplasm.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>India</subject><subject>Kaplan-Meier Estimate</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Lymphoma, B-Cell - drug therapy</subject><subject>Lymphoma, B-Cell - pathology</subject><subject>Lymphoma, B-Cell - radiotherapy</subject><subject>Lymphoma, Large B-Cell, Diffuse - drug therapy</subject><subject>Lymphoma, Large B-Cell, Diffuse - pathology</subject><subject>Lymphoma, Large B-Cell, Diffuse - radiotherapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Staging</subject><subject>Prognosis</subject><subject>Radiotherapy Dosage</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkMtKw0AUhgdRbK1ufACZjS6E1JnJXDJuRIqXQkEXCi6EMJlLE0maOJMs-vZObaCrw-F8_Jz_A-ASozlGiNzpjfZzQjKKj8AUIykShCk5BlOEUJYwmn5NwFkIP3EVhKWnYIIFywgnZAq-333VKL-FpnJuCBbWyq8tLBJt6xrW26Yr20bB1sG-tLBvN6Gq7-EyQAXLal1aD70yVRuPXnUxpY0R3v4Olbfm4RycOFUHezHOGfh8fvpYvCart5fl4nGVaCJon1jpUkMLibEQVmqaGu0yQqSlmqeCUcGJMDq-bLjWpNAcO0Y5404iIrUp0hm42ed2vv0dbOjzpgq7Ampj2yHkPMM0IyKN4O0e1L4NwVuXd_v6OUb5zmW-c5n_u4zw1Zg6FI01B3SUF4HrEVBBq9p5tdFVOHCZZBIJlv4BVD98iQ</recordid><startdate>20070815</startdate><enddate>20070815</enddate><creator>LASKAR, Siddhartha</creator><creator>BAHL, Gaurav</creator><creator>MUCKADEN, Mary Ann</creator><creator>NAIR, Reena</creator><creator>GUPTA, Sudeep</creator><creator>BAKSHI, Ashish</creator><creator>GUJRAL, Sumeet</creator><creator>SHET, Tanuja</creator><creator>SHYAM KISHORE SHRIVASTAVA</creator><creator>KETAYUN ARDESHIR DINSHAW</creator><general>Wiley-Liss</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070815</creationdate><title>Primary diffuse large b-cell lymphoma of the tonsil: Is a higher radiotherapy dose required?</title><author>LASKAR, Siddhartha ; BAHL, Gaurav ; MUCKADEN, Mary Ann ; NAIR, Reena ; GUPTA, Sudeep ; BAKSHI, Ashish ; GUJRAL, Sumeet ; SHET, Tanuja ; SHYAM KISHORE SHRIVASTAVA ; KETAYUN ARDESHIR DINSHAW</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c274t-e9f3d4b91177e9c43dcf8229e4c637547627dc758d6cc2bc61f54656f9029cdb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>India</topic><topic>Kaplan-Meier Estimate</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Lymphoma, B-Cell - drug therapy</topic><topic>Lymphoma, B-Cell - pathology</topic><topic>Lymphoma, B-Cell - radiotherapy</topic><topic>Lymphoma, Large B-Cell, Diffuse - drug therapy</topic><topic>Lymphoma, Large B-Cell, Diffuse - pathology</topic><topic>Lymphoma, Large B-Cell, Diffuse - radiotherapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Staging</topic><topic>Prognosis</topic><topic>Radiotherapy Dosage</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LASKAR, Siddhartha</creatorcontrib><creatorcontrib>BAHL, Gaurav</creatorcontrib><creatorcontrib>MUCKADEN, Mary Ann</creatorcontrib><creatorcontrib>NAIR, Reena</creatorcontrib><creatorcontrib>GUPTA, Sudeep</creatorcontrib><creatorcontrib>BAKSHI, Ashish</creatorcontrib><creatorcontrib>GUJRAL, Sumeet</creatorcontrib><creatorcontrib>SHET, Tanuja</creatorcontrib><creatorcontrib>SHYAM KISHORE SHRIVASTAVA</creatorcontrib><creatorcontrib>KETAYUN ARDESHIR DINSHAW</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LASKAR, Siddhartha</au><au>BAHL, Gaurav</au><au>MUCKADEN, Mary Ann</au><au>NAIR, Reena</au><au>GUPTA, Sudeep</au><au>BAKSHI, Ashish</au><au>GUJRAL, Sumeet</au><au>SHET, Tanuja</au><au>SHYAM KISHORE SHRIVASTAVA</au><au>KETAYUN ARDESHIR DINSHAW</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary diffuse large b-cell lymphoma of the tonsil: Is a higher radiotherapy dose required?</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2007-08-15</date><risdate>2007</risdate><volume>110</volume><issue>4</issue><spage>816</spage><epage>823</epage><pages>816-823</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>The purpose was to evaluate the prognostic factors and treatment outcome of Indian patients with primary diffuse large B-cell lymphoma (DLBCL) of the tonsil treated at a single institution.
In all, 121 patients with DLBCL of the tonsil, treated at the Tata Memorial Hospital, Mumbai, India, from January 1990 to December 2002, were included. The median age was 45 years and the majority of patients (68%) were males. Systemic symptoms were present in 12% of patients; 28% presented with stage I and 67% had stage II disease. Treatment consisted of a combination of chemotherapy (CTh) and radiotherapy (RT) for the majority of patients (69.4%). Among those receiving RT, 64% received an RT dose of > or =45 Gy.
After a median follow-up of 62 months, disease-free survival (DFS) and overall survival (OS) were 66.4% and 81.6%, respectively. Significant prognostic factors included: WHO performance score > or =2 (OS: 72.1% vs 95.6%, P = .016), bulky tumors (OS: 68.5% vs 86.9%, P = .001), presence of B-symptoms (OS: 36.7% vs 79.6%, P < .001), and Ann Arbor stage. On multivariate analysis; WHO performance score > or =2 (hazard ratio [HR], 4.27; 95% confidence interval [CI], 1.20-15.12), and B symptoms (HR, 6.27; 95% CI, 2.38-16.48), retained statistical significance. CTh + RT resulted in a significantly better outcome than those treated with CTh alone (OS: 85.7% vs 70.7%, P = .008). The complete response (P = .053), DFS (P = .039), and OS (P = .014) rates were significantly better for patients receiving an RT dose > or =45 Gy.
Tumor bulk, WHO performance score, the presence of B symptoms, and Ann Arbor stage significantly influence outcome. A combined modality treatment, consisting of CTh and RT (with an RT dose of > or =45 Gy), results in a satisfactory outcome in patients with this uncommon neoplasm.</abstract><cop>New York, NY</cop><pub>Wiley-Liss</pub><pmid>17582622</pmid><doi>10.1002/cncr.22841</doi><tpages>8</tpages></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biological and medical sciences Child Combined Modality Therapy Female Follow-Up Studies Hematologic and hematopoietic diseases Humans India Kaplan-Meier Estimate Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Lymphoma, B-Cell - drug therapy Lymphoma, B-Cell - pathology Lymphoma, B-Cell - radiotherapy Lymphoma, Large B-Cell, Diffuse - drug therapy Lymphoma, Large B-Cell, Diffuse - pathology Lymphoma, Large B-Cell, Diffuse - radiotherapy Male Medical sciences Middle Aged Multivariate Analysis Neoplasm Staging Prognosis Radiotherapy Dosage Treatment Outcome Tumors |
| title | Primary diffuse large b-cell lymphoma of the tonsil: Is a higher radiotherapy dose required? |
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