Albeit not limited to consolidation radiotherapy in DLBCL, treatment recommendations are often built on experience, clinical judgment and guidelines, but ideally should be based on data, preferably from randomized trials. They include different definitions of bulky disease, the use in advanced stages, and the recent implementation of positron emission tomography- computed tomography (PET-CT) in the clinical management. However, significant conceptual issues on its current use outside a clinical trial remain. 5 As such, consolidation radiotherapy is part of the first line treatment of DLBCL in the European Society for Medical Oncology (ESMO) 6 and National Comprehensive Cancer Network (NCCN) guidelines ( physician_gls/pdf/b-cell.pdf (last access: for details see Online Supplementary Table S1). Radiotherapy is now commonly used in localized disease. It was initially used as a primary modality for various lymphomas and was later used as consolidation when anthracycline-containing regimens became available in the 1980s. 3, 4 Radiotherapy is an effective treatment option for patients with aggressive lymphomas. 1, 2 Several attempts with a variety of approaches including the addition of new drugs have so far failed to improve these results. The current standard therapy rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) cures two-thirds of patients. IntroductionĬomprising 35% of all non-Hodgkin lymphomas (NHL), diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults. These results need to be considered in future trials in the PET-CT era. This meta-analysis revealed no survival benefit when consolidation radiotherapy is given to unselected DLBCL patients following chemotherapy. None of the trials used a PET-guided approach. The lack of benefit did not change over time (p-value: 0.95 (tau2: 0.32 I2: 88%), and was also absent for PFS when stratifying for chemotherapy, the use of Rituximab, age, the dose of radiotherapy, application to patients in complete remission and with bulky disease. For the primary endpoint (PFS), we found a hazard ratio (HR) of 0.77 (0.51 to 1.17, pooled (tau2: 0.25 I2: 85%), and a HR of 0.80 (0.53 to 1.21, pooled (bivariate meta-analysis). As three of the eleven trials were retracted, this data is based on 2414 patients. The primary endpoint of this meta-analysis was PFS. We identified 11 trials that evaluated consolidation radiotherapy following chemotherapy in a randomized fashion in 4'584 patients. We evaluated its efficacy with a comprehensive meta-analysis and a systematic search of Pubmed, Embase, Cochrane, and abstracts from ASCO, ASH, ESMO and ASTRO published from June 1966 and December 2018. Radiotherapy is an effective treatment modality for lymphomas, but there is uncertainty on its use as consolidation after chemo-immunotherapy mainly in advanced stages. Rituximab has improved response rates and overall survival in B-cell lymphoma (DLBCL).
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