Early-stage primary bone lymphoma: a retrospective, multicenter Rare Cancer Network (RCN) Study
Department of Radiation Oncology
Medical Subject Headings
Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Combined Modality Therapy; Cyclophosphamide; Disease Progression; Doxorubicin; Female; Humans; Lymphoma; Male; Middle Aged; Neoplasm Recurrence, Local; Prednisone; Radiotherapy Dosage; Rare Diseases; Remission Induction; Retrospective Studies; Survival Rate; Vincristine; Young Adult
Neoplasms | Oncology
PURPOSE: Primary bone lymphoma (PBL) represents less than 1% of all malignant lymphomas. In this study, we assessed the disease profile, outcome, and prognostic factors in patients with Stages I and II PBL.
PATIENTS AND METHODS: Thirteen Rare Cancer Network (RCN) institutions enrolled 116 consecutive patients with PBL treated between 1987 and 2008 in this study. Eighty-seven patients underwent chemoradiotherapy (CXRT) without (78) or with (9) surgery, 15 radiotherapy (RT) without (13) or with (2) surgery, and 14 chemotherapy (CXT) without (9) or with (5) surgery. Median RT dose was 40 Gy (range, 4-60). The median number of CXT cycles was six (range, 2-8). Median follow-up was 41 months (range, 6-242).
RESULTS: The overall response rate at the end of treatment was 91% (complete response [CR] 74%, partial response [PR] 17%). Local recurrence or progression was observed in 12 (10%) patients and systemic recurrence in 17 (15%). The 5-year overall survival (OS), lymphoma-specific survival (LSS), and local control (LC) were 76%, 78%, and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for OS and LSS were International Prognostic Index (IPI) score 40 Gy (p = 0.005). For LC, only CR and Stage I were favorable factors. In multivariate analysis, IPI score, RT dose, CR, and CXT were independently influencing the outcome (OS and LSS). CR was the only predicting factor for LC.
CONCLUSION: This large multicenter retrospective study confirms the good prognosis of early-stage PBL treated with combined CXRT. An adequate dose of RT and complete CXT regime were associated with better outcome.
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Citation: Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):284-91. doi: 10.1016/j.ijrobp.2011.06.1976. Epub 2011 Nov 11. Link to article on publisher's site