De-escalated radiotherapy for indolent primary cutaneous B-cell lymphoma

Deeskalierte Strahlentherapie beim indolenten primär kutanen B-Zell-Lymphom

Abstract

Objective

Radiotherapy (RT) has an established role in the curative treatment of indolent primary cutaneous B‑cell lymphoma (PCBCL). With the role of low-dose regimens such as 2 × 2 Gy being uncertain, we compared conventional-dose RT to a low-dose approach and investigated outcome and toxicities.

Materials and methods

We retrospectively reviewed the medical records of 26 patients with 44 cutaneous lesions treated at our institution between 2007 and 2017, comprising 22 marginal zone lymphoma (PCMZL) lesions and 22 follicle center lymphoma (PCFCL) lesions. Seven lesions (16%) were treated with low-dose RT (LDRT) (4 Gy) and 37 (84%) with conventional-dose RT (≥24 Gy, median 40 Gy). Median follow-up duration was 76 months.

Results

The overall response rate (ORR) was 91% (complete response rate [CRR]: 75%). The 5‑year local control rate (LCR) was 88% and the 10-year LCR was 84%. The response rates were significantly higher following conventional-dose RT (ORR: 92% vs. 86%; CRR: 84% vs. 29%; P = 0.007). In terms of radiation dose, the rate of infield relapses (14% vs. 11%, P = 0.4) and the 5‑year LCR (86% vs. 90%, P = 0.4) were comparable in the LDRT and conventional-dose RT groups. During RT courses, about two-thirds of patients experienced mild toxicities, with grade I and II acute toxicity rates of 61% and 9%, respectively, with lower incidences of grade I (14% vs. 70%) and grade II (0% vs. 8%, P = 0.004) toxicities following LDRT.

Conclusion

This long-term analysis confirms the excellent outcome of RT in the management of PCBCL. The LDRT concept with 4 Gy was associated with a comparable LCR and reduced rates of acute toxicity. However, the response rates were significantly lower for this group and LDRT may therefore not be recommended as standard treatment.

Zusammenfassung

Zielsetzung

Die Strahlentherapie (RT) hat eine etablierte Rolle in der kurativen Behandlung indolenter primär kutaner B‑Zell-Lymphome (PCBCL). Die Rolle einer Niedrigdosis-Behandlung (z. B. 2 × 2 Gy) wird kontrovers diskutiert, sodass in der folgenden Studie ein Vergleich der konventionellen RT-Dosis mit einem Niedrigdosis-Konzept erfolgte und hierbei Effektivität und Toxizitäten analysiert wurden.

Material und Methoden

In einer retrospektiven Analyse wurden 26 Patienten mit 44 kutanen Läsionen identifiziert, die zwischen 2007 und 2017 an unserer Klinik behandelt wurden. Hierunter waren 22 Läsionen von Marginalzonenlymphomen (PCMZL) und 22 Läsionen von Follikelzentrumslymphomen (PCFCL). Es wurden 7 Läsionen (16 %) mit Niedrigdosis-RT (LDRT) (4 Gy) behandelt und 37 Läsionen (84 %) mit einer RT in konventioneller Dosis (≥24 Gy, im Median 40 Gy). Das mediane Follow-up betrug 76 Monate.

Ergebnisse

Die Gesamtansprechrate (ORR) lag bei 91 % (komplette Ansprechrate [CRR]: 75 %). Die 5‑Jahres-Lokalkontrollrate (LCR) war 88 % und die 10-Jahres-LCR 84 %. Die Ansprechraten waren nach Bestrahlung in konventioneller Dosis signifikant höher (ORR: 92 % vs. 86 %; CRR: 84 % vs. 29 %; P = 0,007). Im Hinblick auf die Rate an „Infield“-Rezidiven (14 % vs. 11 %; P = 0,4) und die 5‑Jahres-LCR (86 % vs. 90 %; P = 0,4) waren die Gruppen der LDRT und der konventionellen Bestrahlung vergleichbar. Während der RT traten Grad-I-Toxizitäten bei 61 % und Grad-2-Toxizitäten bei 9 % der Patienten auf, mit signifikant weniger Akuttoxizitäten vom Grad I (14 % vs. 70 %) und vom Grad II (0 % vs. 8 %; P = 0,004) in der LDRT-Gruppe.

Schlussfolgerung

Diese Langzeitanalyse bestätigt die exzellenten Ergebnisse der RT in der Behandlung von PCBCL. Die LDRT mit 4 Gy war mit einer vergleichbaren LCR und niedrigeren Toxizitäten verbunden. Allerdings waren die Ansprechraten signifikant niedriger, sodass die LDRT nicht als Standard empfohlen werden kann.

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Correspondence to Michael Oertel MD.

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Conflict of interest

M. Oertel, K. Elsayad, C. Weishaupt, K. Steinbrink, and H.T. Eich declare that they have no competing interests.

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Oertel, M., Elsayad, K., Weishaupt, C. et al. De-escalated radiotherapy for indolent primary cutaneous B-cell lymphoma. Strahlenther Onkol 196, 126–131 (2020). https://doi.org/10.1007/s00066-019-01541-7

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Keywords

  • Low-dose RT
  • Skin lymphoma
  • Toxicity
  • CLIPI
  • 2 × 2 Gy

Schlüsselwörter

  • Niedrigdosis-Strahlentherapie
  • Hautlymphom
  • Toxizität
  • CLIPI
  • 2 × 2 Gy