title: Involved-field radiotherapy before high-dose therapy and autologous stem-cell rescue in diffuse large-cell lymphoma: long-term disease control and toxicity.
abstract: OBJECTIVE
  To analyze outcome, prognostic factors, and toxicities in patients with diffuse large-cell lymphoma (DLCL) who received involved-field radiotherapy (IFRT) before high-dose chemotherapy with autologous stem-cell rescue (ASCR).
  
  
  METHODS
  Between January 1990 and August 2006, 164 patients with relapsed or refractory DLCL received IFRT at Memorial Sloan-Kettering Cancer Center (New York, NY) before high-dose chemotherapy and ASCR. IFRT was delivered to involved sites measuring more than 5 cm or to sites with residual disease more than 2 cm. Radiotherapy was administered in 1.5-Gy fractions twice daily to a total dose of 30 Gy. Progression-free survival and overall survival were calculated, and short- and long-term toxicity was assessed according to National Cancer Institute Common Toxicity Criteria (version 2.0). Median follow-up was 60 months (range, 2 to 187 months).
  
  
  RESULTS
  Two- and 5-year progression-free survival was 62% and 53%; 2- and 5-year overall survival was 67% and 58%, respectively. Sixty-seven patients relapsed; only 10 patients relapsed completely within the radiotherapy field. There were seven early treatment-related mortalities and 11 secondary cancers (including four myelodysplastic syndromes), one of which occurred within the IFRT site and five after total-body irradiation.
  
  
  CONCLUSIONS
  Minimal treatment-related mortality and morbidity resulted from short, intensive, involved-field radiotherapy before high-dose chemotherapy and ASCR, which was incorporated into a salvage regimen for patients with relapsed/refractory DLCL. This chemoradiotherapy salvage regimen resulted in a low local relapse rate that could potentially translate into an improved total outcome.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10165, USA. yahalomj@mskcc.org
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Hoppe
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Filippa
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.forename: Tarun
authors.initials: T
authors.lastname: Kewalramani
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenet
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D045823:Ileus / Q000209:etiology; D008171:Lung Diseases / Q000209:etiology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome