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Outcomes After Involved-field Radiation Therapy (IFRT) With or Without Rituximab in Patients With Early-stage Low-grade Non-Hodgkin Lymphoma (NHL) Staged With CT and PET

Lukens, John N. MD*; Nasta, Sunita D. MD; Fram, Brianna BS*; Glatstein, Eli MD*; Plastaras, John P. MD, PhD*

American Journal of Clinical Oncology: February 2014 - Volume 37 - Issue 1 - p 35–40
doi: 10.1097/COC.0b013e31826106c9
Original Articles: Hematopoeitic

Objectives: We evaluated whether staging with positron emission tomography (PET) or treatment with rituximab after involved-field radiation therapy (IFRT) results in an improved progression-free survival (PFS) for early-stage indolent non-Hodgkin lymphoma (NHL).

Methods: We identified 42 patients with stage I/II low-grade NHL treated with initial IFRT at our institution between 1992 and 2009, who had been staged with computed tomography (CT) or PET. A retrospective analysis was performed to evaluate PFS according to staging by CT or PET, and by receipt of rituximab after IFRT.

Results: Overall PFS was 68% and 61% at 5 and 10 years, respectively. There was no significant difference in PFS whether patients were staged by CT (n=17) or by PET (n=25), with 5-year PFS rates of 76% and 60%, respectively. Eleven patients received 4 weekly doses of rituximab after IFRT, with no improvement in 5-year PFS: 46% for rituximab-treated patients versus 72% for patients who were not given rituximab. However, more patients who were given rituximab were stage II.

Conclusions: Patients with limited stage indolent NHL staged with either CT or PET and treated with IFRT have favorable PFS compared with historical controls. The administration of 4 weekly doses of rituximab after IFRT did not improve PFS in these patients. The use of rituximab in this setting should be evaluated in a randomized prospective study.

Departments of *Radiation Oncology

Hematology and Oncology, University of Pennsylvania, Philadelphia, PA

Presented at the 2011 ASCO Annual Meeting, June 2011, Chicago, IL.

The authors declare no conflicts of interest.

Reprints: John N. Lukens, MD, Department of Radiation Oncology, The Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2-West, Philadelphia, PA 19104. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc