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Primary Hepatic Lymphoma: A Retrospective, Multicenter Rare Cancer Network Study
E460
International Journal of Radiation Oncology Biology Physics
that can permit patients with chemotherapy resistant lymphoma to undergo SCT, a potentially curative therapy. This approach can provide durable disease control in roughly 50% of patients. This represents an underutilized and potentially curative strategy that should be considered for patients with localized chemo-refractory disease. Author Disclosure: C.C. Pinnix: Consultant; Global Oncology Inc. National treasurer; AAWR. B. Dabaja: None. S.A. Milgrom: None. G.L. Smith: None. V.K. Reed: None. I.Y. Arzu: None. J.R. Westin: None. G. Rondon: None. C. Hosing: None. Y. Nieto: None. S. Ahmed: None.
(17.9%). Regarding the B-symptoms; 20.5% of patients had fever, 17.9% had weight loss, and 10.3% had night sweats. Hepatomegaly was found in 12.8% of patients and splenomegaly was less common (7.7% of patients). One-third of patients had a history of preexisting liver disease. The most common radiological presentation was multiple lesions (51.3%), followed by solitary lesion (38.5%), and diffuse infiltration was present in 7.7% of patients. Liver function tests were elevated in 68.5% of patients who were tested. Two patients were Hepatitis B Ag positive and two patients were HIV positive among patients who were tested. The most common histopathological diagnosis was diffuse large B-cell lymphoma, which was seen in 26 patients (66.7%). Combination chemotherapy (mostly CHOP-based) was administered to 28 patients (71.8%), two patients had also surgery, and only four patients were treated with radiation therapy or chemoradiation therapy. Total radiation therapy doses ranged from 3060 to 4000 cGy. The median survival was 163 months, and 5- and 10-year overall survival (OS) rates were 79% (95% confidence interval [CI]: 66-92%) and 61% (95% CI: 44-78%), respectively. The 5- and 10-year disease-free and lymphomaspecific survival rates were 75% (95% CI: 61-89%) and 58% (95% CI: 40-76%), and 86% (95% CI: 73-99%) and 76% (95% CI: 59-93%); respectively. In univariate analyses (log rank test), there was a positive trend in better overall survival in younger patients (62 years), males, patients who does not have abdominal pain, weight loss, preexisting liver disease, multiple or diffuse lesions, elevated liver enzymes, lower than normal hemoglobin levels and patients treated with chemotherapy, but not statistically significant, most probably due to the small sample size. Conclusion: In this retrospective multicenter RCN study, patients with PHL were presented with their clinical findings and outcome and they had a relatively good prognosis than that reported elsewhere. Multicenter randomized studies are still warranted to establish treatment guidelines, outcome, and prognostic factors. Author Disclosure: G. Ugurluer: None. R.C. Miller: Stock; Tekcapital Europe. Board member; Rare Cancer Network. Board of Trustees; Mayo Clinic Health System Albert Lea Austin. Y. Li: None. J. Thariat: None. P. Ghadjar: None. E. Ozsahin: None.
3148 2 Gy x 2 for Palliation of Indolent Mantle Cell Lymphoma E.C. White and R.T. Hoppe; Stanford University, Stanford, CA Purpose/Objective(s): Indolent non-Hodgkin lymphomas such as follicular and marginal zone lymphoma are highly radiosensitive, and low-dose radiation of 2 Gy x 2 has been well established as an effective palliative regimen for these patients. Mantle cell lymphoma is also known to be radiosensitive and, while often aggressive, can also behave in a similar indolent fashion. We sought to review our experience using 2 Gy x 2 as palliative treatment for indolent mantle cell lymphoma. Materials/Methods: A total of 14 consecutive patients treated to 25 sites of disease from 2006 to 2014 were retrospectively analyzed. Median age was 69 (range 55-80). Two patients had stage II disease, 3 had stage III, and 9 had stage IV. Thirteen patients (93%) had received prior chemotherapy. Treated sites included the head/neck/axilla (nZ14), abdomen/ pelvis/groin (nZ8), and thorax/mediastinum (nZ3). The primary endpoints were response and local relapse rates, which were determined by clinical exam and PET-CT imaging. Results: Mean follow-up was 20 months (range 2-69 months). After 2 Gy x 2, overall local response rate was 88%. Complete response was achieved in 68% of the treated sites, partial response in 20%, stable disease in 8%, and progression in 4%. Symptomatic response or break from chemotherapy was achieved in 94% of patients. Two patients experienced acute grade 1 toxicity (dry mouth), and there was no late toxicity from radiation therapy. Thirteen sites (52%) eventually developed local relapse, with a median time to local relapse of 10 months. At 20 months, the freedom from local relapse rate was 49%. Conclusion: In this series, low-dose radiation with 2 Gy x 2 was effective and well-tolerated for the palliative treatment of indolent mantle cell lymphoma. Author Disclosure: E.C. White: None. R.T. Hoppe: None.
3149 Primary Hepatic Lymphoma: A Retrospective, Multicenter Rare Cancer Network Study G. Ugurluer,1,2 R.C. Miller,3 Y. Li,4 J. Thariat,5 P. Ghadjar,6 and E.M. Ozsahin7; 1Acibadem Adana Hospital, Adana, Turkey, 2Mayo Clinic, Rochester, MN, 3Mayo Clinic, Jacksonville, FL, 4Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, Beijing, China, 5Centre Antoine Lacassagne, Nice, France, 6 Inselspital, Bern University Hospital, Bern, Switzerland, 7Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland Purpose/Objective(s): Primary hepatic lymphoma (PHL) is a rare malignancy, representing less than 1% of all extranodal lymphomas. The purpose of this study was to assess the clinical profile, outcome, and prognostic factors in PHL. Materials/Methods: A retrospective analysis of 39 patients with PHL diagnosed between 1977 and 2012 was performed in the framework of Rare Cancer Network (RCN). Results: Median age was 62 years (range, 23-86 years) with a male-tofemale ratio of 25/14 (1.8). Median follow-up time was 149 months (range, 1-225 months). The most common presenting symptom was abdominal pain or discomfort (53.8% of patients). The other symptoms were; fatigue (17.9%), jaundice (15.4%), anorexia (15.4%), nausea and/or vomiting
3150 Proton Therapy Used for Breast Sparing in Localized Mediastinal Hodgkin’s Lymphoma in Young Female Patients Y.M. Kirova,1 S. Horn,2 and N. Fournier-Bidoz1; 1Institut Curie, Paris, France, 2Centre Oscar Lambret, Lille, France Purpose/Objective(s): We evaluate whether proton therapy for mediastinal HL can further limit radiation exposure to the breasts. Materials/Methods: e simulated 3 treatment plans with conformal radiation therapy (3DCRT), helical Tomotherapy (HT) and proton therapy at the dose of 30 Gy for 14 young female patients with early-stage, mediastinal HL, treated with chemotherapy and involved-field radiation therapy (IFRT). We report the respective doses to the breasts. Interestingly, treatment plans were not specifically designed for breast sparing. Results: Proton therapy significantly lowered the dose to the breasts, with mean doses of 2.76/1.53 Gy to the left and right breast respectively with proton therapy (vs. 4.95/3.88 Gy with Tomotherapy and vs. 5.56/3.58 Gy with 3DCRT), which are relative reduction of doses to the left and right breasts of 50 and 57% respectively compared to 3DCRT, and of 44 and 60% respectively compared to Tomotherapy. Proton therapy best limited lower doses (V4Gy and V10Gy) compared to 3DCRT, while HT could limit the higher doses (V20Gy) at the expense of larger volume irradiated at low doses (V4Gy). Conclusion: As relation between radiation dose to the breasts and SBC seems to be linear, reduction in mean dose to the breasts with proton therapy should transform into further reduction in SBC, compared to IFRT with 3D conformal radiation therapy or Tomotherapy, in proportion as shown. Proton therapy seems highly interesting for breast sparing after curative treatment for HL, but these results need to be confirmed by individualized risk estimations and prospective trials. Author Disclosure: Y.M. Kirova: None. S. Horn: None. N. FournierBidoz: None.
International Journal of Radiation Oncology Biology Physics
that can permit patients with chemotherapy resistant lymphoma to undergo SCT, a potentially curative therapy. This approach can provide durable disease control in roughly 50% of patients. This represents an underutilized and potentially curative strategy that should be considered for patients with localized chemo-refractory disease. Author Disclosure: C.C. Pinnix: Consultant; Global Oncology Inc. National treasurer; AAWR. B. Dabaja: None. S.A. Milgrom: None. G.L. Smith: None. V.K. Reed: None. I.Y. Arzu: None. J.R. Westin: None. G. Rondon: None. C. Hosing: None. Y. Nieto: None. S. Ahmed: None.
(17.9%). Regarding the B-symptoms; 20.5% of patients had fever, 17.9% had weight loss, and 10.3% had night sweats. Hepatomegaly was found in 12.8% of patients and splenomegaly was less common (7.7% of patients). One-third of patients had a history of preexisting liver disease. The most common radiological presentation was multiple lesions (51.3%), followed by solitary lesion (38.5%), and diffuse infiltration was present in 7.7% of patients. Liver function tests were elevated in 68.5% of patients who were tested. Two patients were Hepatitis B Ag positive and two patients were HIV positive among patients who were tested. The most common histopathological diagnosis was diffuse large B-cell lymphoma, which was seen in 26 patients (66.7%). Combination chemotherapy (mostly CHOP-based) was administered to 28 patients (71.8%), two patients had also surgery, and only four patients were treated with radiation therapy or chemoradiation therapy. Total radiation therapy doses ranged from 3060 to 4000 cGy. The median survival was 163 months, and 5- and 10-year overall survival (OS) rates were 79% (95% confidence interval [CI]: 66-92%) and 61% (95% CI: 44-78%), respectively. The 5- and 10-year disease-free and lymphomaspecific survival rates were 75% (95% CI: 61-89%) and 58% (95% CI: 40-76%), and 86% (95% CI: 73-99%) and 76% (95% CI: 59-93%); respectively. In univariate analyses (log rank test), there was a positive trend in better overall survival in younger patients (62 years), males, patients who does not have abdominal pain, weight loss, preexisting liver disease, multiple or diffuse lesions, elevated liver enzymes, lower than normal hemoglobin levels and patients treated with chemotherapy, but not statistically significant, most probably due to the small sample size. Conclusion: In this retrospective multicenter RCN study, patients with PHL were presented with their clinical findings and outcome and they had a relatively good prognosis than that reported elsewhere. Multicenter randomized studies are still warranted to establish treatment guidelines, outcome, and prognostic factors. Author Disclosure: G. Ugurluer: None. R.C. Miller: Stock; Tekcapital Europe. Board member; Rare Cancer Network. Board of Trustees; Mayo Clinic Health System Albert Lea Austin. Y. Li: None. J. Thariat: None. P. Ghadjar: None. E. Ozsahin: None.
3148 2 Gy x 2 for Palliation of Indolent Mantle Cell Lymphoma E.C. White and R.T. Hoppe; Stanford University, Stanford, CA Purpose/Objective(s): Indolent non-Hodgkin lymphomas such as follicular and marginal zone lymphoma are highly radiosensitive, and low-dose radiation of 2 Gy x 2 has been well established as an effective palliative regimen for these patients. Mantle cell lymphoma is also known to be radiosensitive and, while often aggressive, can also behave in a similar indolent fashion. We sought to review our experience using 2 Gy x 2 as palliative treatment for indolent mantle cell lymphoma. Materials/Methods: A total of 14 consecutive patients treated to 25 sites of disease from 2006 to 2014 were retrospectively analyzed. Median age was 69 (range 55-80). Two patients had stage II disease, 3 had stage III, and 9 had stage IV. Thirteen patients (93%) had received prior chemotherapy. Treated sites included the head/neck/axilla (nZ14), abdomen/ pelvis/groin (nZ8), and thorax/mediastinum (nZ3). The primary endpoints were response and local relapse rates, which were determined by clinical exam and PET-CT imaging. Results: Mean follow-up was 20 months (range 2-69 months). After 2 Gy x 2, overall local response rate was 88%. Complete response was achieved in 68% of the treated sites, partial response in 20%, stable disease in 8%, and progression in 4%. Symptomatic response or break from chemotherapy was achieved in 94% of patients. Two patients experienced acute grade 1 toxicity (dry mouth), and there was no late toxicity from radiation therapy. Thirteen sites (52%) eventually developed local relapse, with a median time to local relapse of 10 months. At 20 months, the freedom from local relapse rate was 49%. Conclusion: In this series, low-dose radiation with 2 Gy x 2 was effective and well-tolerated for the palliative treatment of indolent mantle cell lymphoma. Author Disclosure: E.C. White: None. R.T. Hoppe: None.
3149 Primary Hepatic Lymphoma: A Retrospective, Multicenter Rare Cancer Network Study G. Ugurluer,1,2 R.C. Miller,3 Y. Li,4 J. Thariat,5 P. Ghadjar,6 and E.M. Ozsahin7; 1Acibadem Adana Hospital, Adana, Turkey, 2Mayo Clinic, Rochester, MN, 3Mayo Clinic, Jacksonville, FL, 4Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, Beijing, China, 5Centre Antoine Lacassagne, Nice, France, 6 Inselspital, Bern University Hospital, Bern, Switzerland, 7Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland Purpose/Objective(s): Primary hepatic lymphoma (PHL) is a rare malignancy, representing less than 1% of all extranodal lymphomas. The purpose of this study was to assess the clinical profile, outcome, and prognostic factors in PHL. Materials/Methods: A retrospective analysis of 39 patients with PHL diagnosed between 1977 and 2012 was performed in the framework of Rare Cancer Network (RCN). Results: Median age was 62 years (range, 23-86 years) with a male-tofemale ratio of 25/14 (1.8). Median follow-up time was 149 months (range, 1-225 months). The most common presenting symptom was abdominal pain or discomfort (53.8% of patients). The other symptoms were; fatigue (17.9%), jaundice (15.4%), anorexia (15.4%), nausea and/or vomiting
3150 Proton Therapy Used for Breast Sparing in Localized Mediastinal Hodgkin’s Lymphoma in Young Female Patients Y.M. Kirova,1 S. Horn,2 and N. Fournier-Bidoz1; 1Institut Curie, Paris, France, 2Centre Oscar Lambret, Lille, France Purpose/Objective(s): We evaluate whether proton therapy for mediastinal HL can further limit radiation exposure to the breasts. Materials/Methods: e simulated 3 treatment plans with conformal radiation therapy (3DCRT), helical Tomotherapy (HT) and proton therapy at the dose of 30 Gy for 14 young female patients with early-stage, mediastinal HL, treated with chemotherapy and involved-field radiation therapy (IFRT). We report the respective doses to the breasts. Interestingly, treatment plans were not specifically designed for breast sparing. Results: Proton therapy significantly lowered the dose to the breasts, with mean doses of 2.76/1.53 Gy to the left and right breast respectively with proton therapy (vs. 4.95/3.88 Gy with Tomotherapy and vs. 5.56/3.58 Gy with 3DCRT), which are relative reduction of doses to the left and right breasts of 50 and 57% respectively compared to 3DCRT, and of 44 and 60% respectively compared to Tomotherapy. Proton therapy best limited lower doses (V4Gy and V10Gy) compared to 3DCRT, while HT could limit the higher doses (V20Gy) at the expense of larger volume irradiated at low doses (V4Gy). Conclusion: As relation between radiation dose to the breasts and SBC seems to be linear, reduction in mean dose to the breasts with proton therapy should transform into further reduction in SBC, compared to IFRT with 3D conformal radiation therapy or Tomotherapy, in proportion as shown. Proton therapy seems highly interesting for breast sparing after curative treatment for HL, but these results need to be confirmed by individualized risk estimations and prospective trials. Author Disclosure: Y.M. Kirova: None. S. Horn: None. N. FournierBidoz: None.