Definitive radiotherapy for localized follicular lymphoma staged by 18 F-FDG PET-CT: A collaborative study by ILROG

Jessica L. Brady, Michael S. Binkley, Carla Hajj, Monica Chelius, Karen Chau, Alex Balogh, Mario Levis, Andrea Riccardo Filippi, Michael Jones, Michael Mac Manus, Andrew Wirth, Masahiko Oguchi, Anders Krog Vistisen, Therese Youssef Andraos, Andrea K. Ng, Berthe M.P. Aleman, Seo Hee Choi, Youlia Kirova, Sara Hardy, Gabriele ReinartzHans T. Eich, Scott V. Bratman, Louis S. Constine, Chang-Ok Suh, Bouthaina Dabaja, Tarec C. El-Galaly, David C. Hodgson, Umberto Ricardi, Joachim Yahalom, Richard T. Hoppe, N. George Mikhaeel

Research output: Contribution to journalArticle

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Abstract

Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50%. As 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60% of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ‡24 Gy, staged by PET-CT, age ‡18 years, and follow-up ‡3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1%) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9% and 95.7%. For stage I, FFP was 74.1% vs 49.1% for stage II (P < .0001). Eight patients relapsed in-field (1.6%). Four had marginal recurrences (0.8%) resulting in local control rate of 97.6%. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95% CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated.

Original languageEnglish
Pages (from-to)237-245
Number of pages9
JournalBlood
Volume133
Issue number3
DOIs
Publication statusPublished - 2019 Jan 17

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Follicular Lymphoma
Radiation Oncology
Positron emission tomography
Oncology
Computerized tomography
Radiotherapy
Positron-Emission Tomography
Lymphoma
Tomography
Radiation
Hazards
Fluorodeoxyglucose F18
Confidence Intervals
Dosimetry
Survival
Patient Selection
Multicenter Studies
Disease-Free Survival
Retrospective Studies
Recurrence

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Brady, J. L., Binkley, M. S., Hajj, C., Chelius, M., Chau, K., Balogh, A., ... Mikhaeel, N. G. (2019). Definitive radiotherapy for localized follicular lymphoma staged by 18 F-FDG PET-CT: A collaborative study by ILROG. Blood, 133(3), 237-245. https://doi.org/10.1182/blood-2018-04-843540
Brady, Jessica L. ; Binkley, Michael S. ; Hajj, Carla ; Chelius, Monica ; Chau, Karen ; Balogh, Alex ; Levis, Mario ; Filippi, Andrea Riccardo ; Jones, Michael ; Manus, Michael Mac ; Wirth, Andrew ; Oguchi, Masahiko ; Vistisen, Anders Krog ; Andraos, Therese Youssef ; Ng, Andrea K. ; Aleman, Berthe M.P. ; Choi, Seo Hee ; Kirova, Youlia ; Hardy, Sara ; Reinartz, Gabriele ; Eich, Hans T. ; Bratman, Scott V. ; Constine, Louis S. ; Suh, Chang-Ok ; Dabaja, Bouthaina ; El-Galaly, Tarec C. ; Hodgson, David C. ; Ricardi, Umberto ; Yahalom, Joachim ; Hoppe, Richard T. ; Mikhaeel, N. George. / Definitive radiotherapy for localized follicular lymphoma staged by 18 F-FDG PET-CT : A collaborative study by ILROG. In: Blood. 2019 ; Vol. 133, No. 3. pp. 237-245.
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abstract = "Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50{\%}. As 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60{\%} of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ‡24 Gy, staged by PET-CT, age ‡18 years, and follow-up ‡3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1{\%}) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9{\%} and 95.7{\%}. For stage I, FFP was 74.1{\%} vs 49.1{\%} for stage II (P < .0001). Eight patients relapsed in-field (1.6{\%}). Four had marginal recurrences (0.8{\%}) resulting in local control rate of 97.6{\%}. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95{\%} confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95{\%} CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated.",
author = "Brady, {Jessica L.} and Binkley, {Michael S.} and Carla Hajj and Monica Chelius and Karen Chau and Alex Balogh and Mario Levis and Filippi, {Andrea Riccardo} and Michael Jones and Manus, {Michael Mac} and Andrew Wirth and Masahiko Oguchi and Vistisen, {Anders Krog} and Andraos, {Therese Youssef} and Ng, {Andrea K.} and Aleman, {Berthe M.P.} and Choi, {Seo Hee} and Youlia Kirova and Sara Hardy and Gabriele Reinartz and Eich, {Hans T.} and Bratman, {Scott V.} and Constine, {Louis S.} and Chang-Ok Suh and Bouthaina Dabaja and El-Galaly, {Tarec C.} and Hodgson, {David C.} and Umberto Ricardi and Joachim Yahalom and Hoppe, {Richard T.} and Mikhaeel, {N. George}",
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Brady, JL, Binkley, MS, Hajj, C, Chelius, M, Chau, K, Balogh, A, Levis, M, Filippi, AR, Jones, M, Manus, MM, Wirth, A, Oguchi, M, Vistisen, AK, Andraos, TY, Ng, AK, Aleman, BMP, Choi, SH, Kirova, Y, Hardy, S, Reinartz, G, Eich, HT, Bratman, SV, Constine, LS, Suh, C-O, Dabaja, B, El-Galaly, TC, Hodgson, DC, Ricardi, U, Yahalom, J, Hoppe, RT & Mikhaeel, NG 2019, 'Definitive radiotherapy for localized follicular lymphoma staged by 18 F-FDG PET-CT: A collaborative study by ILROG', Blood, vol. 133, no. 3, pp. 237-245. https://doi.org/10.1182/blood-2018-04-843540

Definitive radiotherapy for localized follicular lymphoma staged by 18 F-FDG PET-CT : A collaborative study by ILROG. / Brady, Jessica L.; Binkley, Michael S.; Hajj, Carla; Chelius, Monica; Chau, Karen; Balogh, Alex; Levis, Mario; Filippi, Andrea Riccardo; Jones, Michael; Manus, Michael Mac; Wirth, Andrew; Oguchi, Masahiko; Vistisen, Anders Krog; Andraos, Therese Youssef; Ng, Andrea K.; Aleman, Berthe M.P.; Choi, Seo Hee; Kirova, Youlia; Hardy, Sara; Reinartz, Gabriele; Eich, Hans T.; Bratman, Scott V.; Constine, Louis S.; Suh, Chang-Ok; Dabaja, Bouthaina; El-Galaly, Tarec C.; Hodgson, David C.; Ricardi, Umberto; Yahalom, Joachim; Hoppe, Richard T.; Mikhaeel, N. George.

In: Blood, Vol. 133, No. 3, 17.01.2019, p. 237-245.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Definitive radiotherapy for localized follicular lymphoma staged by 18 F-FDG PET-CT

T2 - A collaborative study by ILROG

AU - Brady, Jessica L.

AU - Binkley, Michael S.

AU - Hajj, Carla

AU - Chelius, Monica

AU - Chau, Karen

AU - Balogh, Alex

AU - Levis, Mario

AU - Filippi, Andrea Riccardo

AU - Jones, Michael

AU - Manus, Michael Mac

AU - Wirth, Andrew

AU - Oguchi, Masahiko

AU - Vistisen, Anders Krog

AU - Andraos, Therese Youssef

AU - Ng, Andrea K.

AU - Aleman, Berthe M.P.

AU - Choi, Seo Hee

AU - Kirova, Youlia

AU - Hardy, Sara

AU - Reinartz, Gabriele

AU - Eich, Hans T.

AU - Bratman, Scott V.

AU - Constine, Louis S.

AU - Suh, Chang-Ok

AU - Dabaja, Bouthaina

AU - El-Galaly, Tarec C.

AU - Hodgson, David C.

AU - Ricardi, Umberto

AU - Yahalom, Joachim

AU - Hoppe, Richard T.

AU - Mikhaeel, N. George

PY - 2019/1/17

Y1 - 2019/1/17

N2 - Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50%. As 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60% of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ‡24 Gy, staged by PET-CT, age ‡18 years, and follow-up ‡3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1%) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9% and 95.7%. For stage I, FFP was 74.1% vs 49.1% for stage II (P < .0001). Eight patients relapsed in-field (1.6%). Four had marginal recurrences (0.8%) resulting in local control rate of 97.6%. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95% CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated.

AB - Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50%. As 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60% of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ‡24 Gy, staged by PET-CT, age ‡18 years, and follow-up ‡3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1%) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9% and 95.7%. For stage I, FFP was 74.1% vs 49.1% for stage II (P < .0001). Eight patients relapsed in-field (1.6%). Four had marginal recurrences (0.8%) resulting in local control rate of 97.6%. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95% CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated.

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