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Response to Low-Dose Involved-Field Radiotherapy (LD-IF-RT) in Patients With Non-Hodgkin's Lymphoma (NHL)
I. J. Radiation Oncology d Biology d Physics
S532
Volume 69, Number 3, Supplement, 2007
the 23 patients treated with CT and RT, the baseline median %DLCO was 107% (range, 69–139%). Median %DLCO at post-CT/ pre-RT, and at 1 month, 6 months and 1 year post-RT decreased 16.5% (p = 0.0005), 16% (p = 0.007), 14.5% (p = 0.0006), and 12.5% (p = 0.003) from baseline, respectively. There was no significant further decline in %DLCO between post-CT/pre-RT and subsequent time points post-RT. Persistently reduced %DLCO (.15% decline from baseline) was observed in 35% and 28% of patients at 6 months and 1 year, respectively. In patients who received RT, having .33% of lung volume receive 20 Gy (V20) and a mean lung dose (MLD) of .13 Gy significantly predicted for persistently depressed %DLCO at 6 months (p = 0.035) but not at 1 year. Smoking significantly predicted for a persistently depressed %DLCO at 1 year (p = 0.036). Three patients had radiation pneumonitis (RP) requiring treatment. Their MLD (11.1 Gy, 13.3 Gy and 13.9 Gy) and V20 (27%, 33% and 36%) did not differ significantly from the MLD (median, 11.2 Gy; range 7.8–14.1 Gy) and V20 (median, 29%; range 20–39%) of patients without RP (p = 0.27). Three of 6 patients (50%) age .60 had bleomycin toxicity requiring discontinuation of the drug compared to 3/46 (7%) age \60 (p = 0.016). On multivarate analysis, after adjusting for age, number of cycles of bleomycin, and smoking history, significant predictors for decline in %DLCO at 1 year were addition of RT (p = 0.048) and higher baseline %DLCO (p = 0.01). There were no significant changes in general dyspnea, fatigue and activity scores over time in both cohorts. Conclusions: Treatment with bleomycin-based CT for HL resulted in a significant decline in %DLCO, which returned to baseline within 6 months post-CT. The addition of mediastinal RT did not further reduce the %DLCO, but did result in persistently decreased %DLCO up to 1 year post-therapy. Improvement in lung function in response to treatment in patients whose low baseline %DLCO is a result of their mediastinal disease may offset treatment-related lung function impairment. This may explain the association between a higher baseline %DLCO and greater decline in lung function at 1 year. Radiation dosimetric parameters had a temporary effect on %DLCO, but was not predictive of risk of RP; however, a correlation at higher lung doses cannot be ruled out. Author Disclosure: A.K. Ng, American Society of Hematology Clinical Research Junior Faculty Award, B. Research Grant; S. Li, None; D.C. Fisher, None; B. Silver, None; P.M. Mauch, None.
2591
Response to Low-Dose Involved-Field Radiotherapy (LD-IF-RT) in Patients With Non-Hodgkin’s Lymphoma (NHL)
S. K. Luthy1, A. K. Ng1, A. S. Freedman2, B. Silver1, P. M. Mauch1 1 Department of Radiation Oncology, Brigham & Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, 2 Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA Purpose/Objective(s): To analyze response to palliative treatment with LD-IF-RT (2-Gy fractions over two consecutive days) and to determine the timecourse to subsequent treatment in patients with NHL. Materials/Methods: Between April 2004 and March 2007, 31 patients (18 male and 13 female) with advanced or recurrent NHL received LD-IF-RT to a total of 39 sites at our institution. Included were 27 patients (87%) with follicular lymphoma, two (6%) with extranodal marginal zone lymphoma and two (6%) with mantle cell lymphoma. Twenty treatments (51%) were to the head and neck, 11 (28%) to pelvic and/or inguinofemoral nodes, four (10%) to cutaneous sites, three (8%) to other peripheral nodes and one (3%) was to the breast. Median age at initial diagnosis was 52 years (range, 28–75), median age at first LD-IF-RT treatment was 57 years (range, 28–78) and median time between diagnosis and the start of LD-IF-RT was 53 months (range, 2–217). The primary endpoint was in-field lymphoma control, which was assessed by physical examination and radiographic studies. Median follow-up time for each site was 10 months (range, 0–34). Fisher’s exact test was used to evaluate prognostic factors for response and in-field progression. Results: The overall response rate was 95%. Thirty-three sites (85%) had a complete response (CR) and four sites (10%) had a partial response (PR); two sites (5%) had progressive disease (PD). The CR rate of the head and neck sites was significantly higher than that of the pelvic and/or inguinofemoral sites (95% vs. 64%, p = 0.04). Seven (18%) of the 39 treated sites had in-field recurrence at a median of six months (range, 0–11). There was a non-significant trend that sites with an initial CR were less likely to have an infield recurrence than those without an initial CR (12% vs. 50%, p = 0.06). Five of the seven in-field recurrences were retreated with conventional-dose RT, resulting in a CR in four sites and a PR in one site. One in-field recurrence was retreated with LD-IF-RT, resulting in a PR. Overall, 13 of the 31 patients (42%) received subsequent systemic treatment at a median of eight months (range, 0–26) after LD-IF-RT; 12 were treated for out-of-field disease progression and one was for in-field recurrence. Fourteen of the 31 patients (45%) did not require any additional treatment; median follow-up time for these patients was 7.5 months (range, 0–27). A total of five patients (16%) had transformation to an aggressive histology at a median of 10 months (range, 2–31). Conclusions: LD-IF-RT, as palliative treatment for selected subtypes of NHL, is associated with excellent local CR and in-field control rates, and may postpone the need for systemic therapy. Our finding of a higher response rate in head and neck sites is encouraging, as patients presenting in these sites may particularly benefit from LD-IF-RT because of the high toxicity of conventional-dose RT to this area. Author Disclosure: S.K. Luthy, None; A.K. Ng, None; A.S. Freedman, None; B. Silver, None; P.M. Mauch, None.
2592
Characterization of Non-Gastric MALT Lymphomas Identified in the SEER Database
K. B. Roberts, R. C. Blitzblau, L. D. Wilson Yale University School of Medicine, New Haven, CT Purpose/Objective(s): Mucosa-associated lymphoid tissue (MALT) lymphomas, a class of non-Hodgkin’s lymphoma, most commonly occur in the stomach but present in many other body sites as well. While there has been a significant amount of research on gastric MALTomas, relatively little is known about other primary sites, and published series are small. We sought to characterize a larger cohort of patients with non-gastric MALT lymphoma. Materials/Methods: We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database using the ICD-02 MALT lymphoma histological code. We searched from 1994, the year MALT lymphomas were first recognized in REAL classification, to 2001 (due to a change in ICD coding, there are no MALT coded lymphomas after 2001). ICD primary
S532
Volume 69, Number 3, Supplement, 2007
the 23 patients treated with CT and RT, the baseline median %DLCO was 107% (range, 69–139%). Median %DLCO at post-CT/ pre-RT, and at 1 month, 6 months and 1 year post-RT decreased 16.5% (p = 0.0005), 16% (p = 0.007), 14.5% (p = 0.0006), and 12.5% (p = 0.003) from baseline, respectively. There was no significant further decline in %DLCO between post-CT/pre-RT and subsequent time points post-RT. Persistently reduced %DLCO (.15% decline from baseline) was observed in 35% and 28% of patients at 6 months and 1 year, respectively. In patients who received RT, having .33% of lung volume receive 20 Gy (V20) and a mean lung dose (MLD) of .13 Gy significantly predicted for persistently depressed %DLCO at 6 months (p = 0.035) but not at 1 year. Smoking significantly predicted for a persistently depressed %DLCO at 1 year (p = 0.036). Three patients had radiation pneumonitis (RP) requiring treatment. Their MLD (11.1 Gy, 13.3 Gy and 13.9 Gy) and V20 (27%, 33% and 36%) did not differ significantly from the MLD (median, 11.2 Gy; range 7.8–14.1 Gy) and V20 (median, 29%; range 20–39%) of patients without RP (p = 0.27). Three of 6 patients (50%) age .60 had bleomycin toxicity requiring discontinuation of the drug compared to 3/46 (7%) age \60 (p = 0.016). On multivarate analysis, after adjusting for age, number of cycles of bleomycin, and smoking history, significant predictors for decline in %DLCO at 1 year were addition of RT (p = 0.048) and higher baseline %DLCO (p = 0.01). There were no significant changes in general dyspnea, fatigue and activity scores over time in both cohorts. Conclusions: Treatment with bleomycin-based CT for HL resulted in a significant decline in %DLCO, which returned to baseline within 6 months post-CT. The addition of mediastinal RT did not further reduce the %DLCO, but did result in persistently decreased %DLCO up to 1 year post-therapy. Improvement in lung function in response to treatment in patients whose low baseline %DLCO is a result of their mediastinal disease may offset treatment-related lung function impairment. This may explain the association between a higher baseline %DLCO and greater decline in lung function at 1 year. Radiation dosimetric parameters had a temporary effect on %DLCO, but was not predictive of risk of RP; however, a correlation at higher lung doses cannot be ruled out. Author Disclosure: A.K. Ng, American Society of Hematology Clinical Research Junior Faculty Award, B. Research Grant; S. Li, None; D.C. Fisher, None; B. Silver, None; P.M. Mauch, None.
2591
Response to Low-Dose Involved-Field Radiotherapy (LD-IF-RT) in Patients With Non-Hodgkin’s Lymphoma (NHL)
S. K. Luthy1, A. K. Ng1, A. S. Freedman2, B. Silver1, P. M. Mauch1 1 Department of Radiation Oncology, Brigham & Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, 2 Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA Purpose/Objective(s): To analyze response to palliative treatment with LD-IF-RT (2-Gy fractions over two consecutive days) and to determine the timecourse to subsequent treatment in patients with NHL. Materials/Methods: Between April 2004 and March 2007, 31 patients (18 male and 13 female) with advanced or recurrent NHL received LD-IF-RT to a total of 39 sites at our institution. Included were 27 patients (87%) with follicular lymphoma, two (6%) with extranodal marginal zone lymphoma and two (6%) with mantle cell lymphoma. Twenty treatments (51%) were to the head and neck, 11 (28%) to pelvic and/or inguinofemoral nodes, four (10%) to cutaneous sites, three (8%) to other peripheral nodes and one (3%) was to the breast. Median age at initial diagnosis was 52 years (range, 28–75), median age at first LD-IF-RT treatment was 57 years (range, 28–78) and median time between diagnosis and the start of LD-IF-RT was 53 months (range, 2–217). The primary endpoint was in-field lymphoma control, which was assessed by physical examination and radiographic studies. Median follow-up time for each site was 10 months (range, 0–34). Fisher’s exact test was used to evaluate prognostic factors for response and in-field progression. Results: The overall response rate was 95%. Thirty-three sites (85%) had a complete response (CR) and four sites (10%) had a partial response (PR); two sites (5%) had progressive disease (PD). The CR rate of the head and neck sites was significantly higher than that of the pelvic and/or inguinofemoral sites (95% vs. 64%, p = 0.04). Seven (18%) of the 39 treated sites had in-field recurrence at a median of six months (range, 0–11). There was a non-significant trend that sites with an initial CR were less likely to have an infield recurrence than those without an initial CR (12% vs. 50%, p = 0.06). Five of the seven in-field recurrences were retreated with conventional-dose RT, resulting in a CR in four sites and a PR in one site. One in-field recurrence was retreated with LD-IF-RT, resulting in a PR. Overall, 13 of the 31 patients (42%) received subsequent systemic treatment at a median of eight months (range, 0–26) after LD-IF-RT; 12 were treated for out-of-field disease progression and one was for in-field recurrence. Fourteen of the 31 patients (45%) did not require any additional treatment; median follow-up time for these patients was 7.5 months (range, 0–27). A total of five patients (16%) had transformation to an aggressive histology at a median of 10 months (range, 2–31). Conclusions: LD-IF-RT, as palliative treatment for selected subtypes of NHL, is associated with excellent local CR and in-field control rates, and may postpone the need for systemic therapy. Our finding of a higher response rate in head and neck sites is encouraging, as patients presenting in these sites may particularly benefit from LD-IF-RT because of the high toxicity of conventional-dose RT to this area. Author Disclosure: S.K. Luthy, None; A.K. Ng, None; A.S. Freedman, None; B. Silver, None; P.M. Mauch, None.
2592
Characterization of Non-Gastric MALT Lymphomas Identified in the SEER Database
K. B. Roberts, R. C. Blitzblau, L. D. Wilson Yale University School of Medicine, New Haven, CT Purpose/Objective(s): Mucosa-associated lymphoid tissue (MALT) lymphomas, a class of non-Hodgkin’s lymphoma, most commonly occur in the stomach but present in many other body sites as well. While there has been a significant amount of research on gastric MALTomas, relatively little is known about other primary sites, and published series are small. We sought to characterize a larger cohort of patients with non-gastric MALT lymphoma. Materials/Methods: We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database using the ICD-02 MALT lymphoma histological code. We searched from 1994, the year MALT lymphomas were first recognized in REAL classification, to 2001 (due to a change in ICD coding, there are no MALT coded lymphomas after 2001). ICD primary