MACOP-B and Involved-Field Radiotherapy Is an Effective and Safe Therapy for Primary Mediastinal Large B Cell Lymphoma

• Published in: International journal of radiation oncology, biology, physics Vol. 72; no. 4; pp. 1154 - 1160
• Main Authors: De Sanctis, Vitaliana, Finolezzi, Erica, Osti, Mattia Falchetto, Grapulin, Lavinia, Alfò, Marco, Pescarmona, Edoardo, Berardi, Francesca, Natalino, Fiammetta, Moleti, Maria Luisa, Di Rocco, Alice, Enrici, Riccardo Maurizi, Foà, Robin, Martelli, Maurizio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.11.2008
• Subjects: 67Gallium scintigraphy; Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; BLEOMYCIN; Bleomycin - administration & dosage; CHEMOTHERAPY; Cyclophosphamide - administration & dosage; DOXORUBICIN; Doxorubicin - administration & dosage; ENDOXAN; GALLIUM 67; Hematology, Oncology and Palliative Medicine; Humans; Italy - epidemiology; Leucovorin - administration & dosage; Longitudinal Studies; Lymphoma, B-Cell - mortality; Lymphoma, B-Cell - therapy; LYMPHOMAS; Mediastinal Neoplasms - mortality; Mediastinal Neoplasms - therapy; METHOTREXATE; Methotrexate - administration & dosage; Middle Aged; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; Positron emission tomography; PREDNISONE; Prednisone - administration & dosage; Prevalence; Primary mediastinal large B cell lymphoma; RADIATION DOSES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Adjuvant; SCINTISCANNING; Survival Analysis; Survival Rate; Treatment Outcome; Vincristine - administration & dosage; Italy; 67Gallium scintigraphy; Chemotherapy; Radiotherapy; Positron emission tomography; Primary mediastinal large B cell lymphoma
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2008.02.036

To report the clinical findings and long-term results of front-line, third-generation MACOP-B (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin) chemotherapy and mediastinal involved-field radiotherapy (IFRT) in 85 consecutive, previously untreated patients with primary mediastinal large B cell lymphoma (PMLBCL) diagnosed and managed at a single institution. Between 1991 and April 2004, 92 consecutive, untreated patients with PMLBCL were treated at our institution. The median age was 33 years (range, 15–61 years), 46 patients (50%) showed a mediastinal syndrome at onset; 52 patients (57%) showed a low/low–intermediate (0 to 1) and 40 patients (43%) an intermediate–high/high (2 to 3) International Prognostic Index (IPI) score. Eighty-five patients were treated with standard chemotherapy (MACOP-B), and 80 underwent mediastinal IFRT at a dose of 30–36 Gy. After a MACOP-B regimen, the overall response rate was 87% and the partial response rate 9%. After chemotherapy, 67Ga scintigraphy/positron emission tomography results were positive in 43 of 52 patients (83%), whereas after IFRT 11 of 52 patients (21%) remained positive ( p < 0.0001). After a median follow-up of 81 months (range, 2–196 months), progression or relapse was observed in 15 of 84 patients (18%). The projected 5-year overall survival and progression-free survival rates were 87% and 81%, respectively. The 5-year overall survival and progression-free survival rates were better for patients with an IPI of 0 to 1 than for those with an IPI of 2 to 3 (96% vs. 73% [ p = 0.002] and 90% vs. 67% [ p = 0.007], respectively). Combined-modality treatment with intensive chemotherapy plus mediastinal IFRT induces high response and lymphoma-free survival rates. Involved-field RT plays an important role in inducing negative results on 67Ga scintigraphy/positron emission tomography in patients responsive to chemotherapy.