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Radiotherapy Compared to Other Strategies in the Treatment of Stage I/II Follicular Lymphoma: A Study of 404 Patients with a Median Follow-Up of 15 Years.

Barzenje DA, Cvancarova Småstuen M, Liestøl K, Fosså A, Delabie J, Kolstad A, Holte H - PLoS ONE (2015)

Bottom Line: No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer.Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Ostfold Hospital Trust, Fredrikstad, Norway.

ABSTRACT

Purpose: To investigate outcome for patients with follicular lymphoma (FL) stage I-II treated at a population-based referral institution with a median follow-up of 15 years. Overall and cause-specific survival was compared to that of a sex, age and residency matched individuals from normal population.

Material and methods: 404 patients with early stage FL treated between 1980 and 2005 were retrospectively analyzed. Two of three patients had stage I disease. Based on clinical characteristics, first line treatments were radiotherapy (RT) (48% of patients), chemotherapy (CT) (16%), combined chemo-and radiotherapy (CRT) (16%) or observation (OBS) (15%). Survival was modeled with Kaplan-Meier methodology. Multivariate analyses were performed with the Cox model.

Results: Fifteen years overall survival (OS), progression free survival (PFS) and time to next treatment (TNT) were 50% (95% confidence interval [CI]: 45-55), 42% (95% CI: 36-47) and 48% (95% CI, 42-54), respectively. For patients treated with RT 97% achieved a complete remission, and 15 year OS, PFS and TNT were 57% (95% CI, 50-64), 46% (95% CI, 39-54) and 49% (95% CI, 42-57), respectively. Relapse rate after RT and CRT was 49% and 36%, respectively. Only 2% of patients who received RT or CRT relapsed inside the radiation field and 5% had isolated near-field relapse. No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer. Compared to a matched normal population, non-lymphoma cancer mortality was higher among patients given RT, hazard ratio 1.66 (95% CI: 1.14-2.42; P<0.01). Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.

Conclusions: A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients. OBS is a valid initial choice for selected patients without lymphoma-related symptoms.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival curves showing overall survival (OS), progression free survival (PFS) and time to next treatment (TNT).Survival curves are illustrated as follows: (A) OS for all follicular lymphoma (FL) patients; (B) PFS for all FL patients; (C) TNT for all FL patients; (D) OS by stage; (E) PFS by stage; (F)TNT by stage; (G) OS by involvement site; (H) PFS by involvement site; (I) TNT by involvement site; (J) OS by treatment type; (K) PFS by treatment type; and (L) TNT by treatment type. Note: Pointwise confidence bands are not shown when survival curves overlap or run close to each other. P-values in (D) to (I) are from log-rank tests comparing the two groups, in (J) to (L) from generalized log-rank tests comparing all groups.
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pone.0131158.g001: Kaplan-Meier survival curves showing overall survival (OS), progression free survival (PFS) and time to next treatment (TNT).Survival curves are illustrated as follows: (A) OS for all follicular lymphoma (FL) patients; (B) PFS for all FL patients; (C) TNT for all FL patients; (D) OS by stage; (E) PFS by stage; (F)TNT by stage; (G) OS by involvement site; (H) PFS by involvement site; (I) TNT by involvement site; (J) OS by treatment type; (K) PFS by treatment type; and (L) TNT by treatment type. Note: Pointwise confidence bands are not shown when survival curves overlap or run close to each other. P-values in (D) to (I) are from log-rank tests comparing the two groups, in (J) to (L) from generalized log-rank tests comparing all groups.

Mentions: OS at 10, 15 and 20 years was 63% (95% CI: 58–68), 50% (95% CI: 45–55) and 38% (95% CI: 32–44), respectively (Fig 1A). There were no statistically significant differences in OS between stages I and II (P = 0.25) (Fig 1D). There was a significant difference between the treatment groups (P = 0.002) (Fig 1J). OS was significantly better in the cohort treated with RT compared to patients treated with CT (P < .01). There was a trend towards longer OS in the RT group compared to the OBS group (P = 0.054) but no difference between RT and CRT (P = 0.66). OS was significantly better for patients with subdiaphragmatic disease involvement (P<0.01) (Fig 1G), FLIPI score 0 (P<0.01), WHO performance status 0 (P<0.01), and age <61 years (P<0.01) compared to supradiaphragmatic disease, FLIPI score ≥1, WHO ≥1 and age ≥61 years. Within OBS group no significant difference were found between patients who underwent surgical tumor excision and those who did not (P = 0.74).


Radiotherapy Compared to Other Strategies in the Treatment of Stage I/II Follicular Lymphoma: A Study of 404 Patients with a Median Follow-Up of 15 Years.

Barzenje DA, Cvancarova Småstuen M, Liestøl K, Fosså A, Delabie J, Kolstad A, Holte H - PLoS ONE (2015)

Kaplan-Meier survival curves showing overall survival (OS), progression free survival (PFS) and time to next treatment (TNT).Survival curves are illustrated as follows: (A) OS for all follicular lymphoma (FL) patients; (B) PFS for all FL patients; (C) TNT for all FL patients; (D) OS by stage; (E) PFS by stage; (F)TNT by stage; (G) OS by involvement site; (H) PFS by involvement site; (I) TNT by involvement site; (J) OS by treatment type; (K) PFS by treatment type; and (L) TNT by treatment type. Note: Pointwise confidence bands are not shown when survival curves overlap or run close to each other. P-values in (D) to (I) are from log-rank tests comparing the two groups, in (J) to (L) from generalized log-rank tests comparing all groups.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492987&req=5

pone.0131158.g001: Kaplan-Meier survival curves showing overall survival (OS), progression free survival (PFS) and time to next treatment (TNT).Survival curves are illustrated as follows: (A) OS for all follicular lymphoma (FL) patients; (B) PFS for all FL patients; (C) TNT for all FL patients; (D) OS by stage; (E) PFS by stage; (F)TNT by stage; (G) OS by involvement site; (H) PFS by involvement site; (I) TNT by involvement site; (J) OS by treatment type; (K) PFS by treatment type; and (L) TNT by treatment type. Note: Pointwise confidence bands are not shown when survival curves overlap or run close to each other. P-values in (D) to (I) are from log-rank tests comparing the two groups, in (J) to (L) from generalized log-rank tests comparing all groups.
Mentions: OS at 10, 15 and 20 years was 63% (95% CI: 58–68), 50% (95% CI: 45–55) and 38% (95% CI: 32–44), respectively (Fig 1A). There were no statistically significant differences in OS between stages I and II (P = 0.25) (Fig 1D). There was a significant difference between the treatment groups (P = 0.002) (Fig 1J). OS was significantly better in the cohort treated with RT compared to patients treated with CT (P < .01). There was a trend towards longer OS in the RT group compared to the OBS group (P = 0.054) but no difference between RT and CRT (P = 0.66). OS was significantly better for patients with subdiaphragmatic disease involvement (P<0.01) (Fig 1G), FLIPI score 0 (P<0.01), WHO performance status 0 (P<0.01), and age <61 years (P<0.01) compared to supradiaphragmatic disease, FLIPI score ≥1, WHO ≥1 and age ≥61 years. Within OBS group no significant difference were found between patients who underwent surgical tumor excision and those who did not (P = 0.74).

Bottom Line: No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer.Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Ostfold Hospital Trust, Fredrikstad, Norway.

ABSTRACT

Purpose: To investigate outcome for patients with follicular lymphoma (FL) stage I-II treated at a population-based referral institution with a median follow-up of 15 years. Overall and cause-specific survival was compared to that of a sex, age and residency matched individuals from normal population.

Material and methods: 404 patients with early stage FL treated between 1980 and 2005 were retrospectively analyzed. Two of three patients had stage I disease. Based on clinical characteristics, first line treatments were radiotherapy (RT) (48% of patients), chemotherapy (CT) (16%), combined chemo-and radiotherapy (CRT) (16%) or observation (OBS) (15%). Survival was modeled with Kaplan-Meier methodology. Multivariate analyses were performed with the Cox model.

Results: Fifteen years overall survival (OS), progression free survival (PFS) and time to next treatment (TNT) were 50% (95% confidence interval [CI]: 45-55), 42% (95% CI: 36-47) and 48% (95% CI, 42-54), respectively. For patients treated with RT 97% achieved a complete remission, and 15 year OS, PFS and TNT were 57% (95% CI, 50-64), 46% (95% CI, 39-54) and 49% (95% CI, 42-57), respectively. Relapse rate after RT and CRT was 49% and 36%, respectively. Only 2% of patients who received RT or CRT relapsed inside the radiation field and 5% had isolated near-field relapse. No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer. Compared to a matched normal population, non-lymphoma cancer mortality was higher among patients given RT, hazard ratio 1.66 (95% CI: 1.14-2.42; P<0.01). Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.

Conclusions: A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients. OBS is a valid initial choice for selected patients without lymphoma-related symptoms.

No MeSH data available.


Related in: MedlinePlus