Abstract

Introduction: We report successful treatment of mesenteric diffuse large B-cell lymphoma (DLBCL) using localized involved site radiation therapy (ISRT), intensity modulated radiation therapy (IMRT), and daily computed tomography (CT)-image guidance. Patients and Methods: Patients with mesenteric DLBCL treated with RT between 2011 and 2017 were reviewed. Clinical and treatment characteristics were analyzed for an association with local control, progression-free survival (PFS), and overall survival. Results: Twenty-three patients were eligible. At diagnosis, the median age was 52 years (range, 38-76 years), and 57% (n = 13) had stage I/II DLBCL. All patients received frontline chemotherapy (ChT) (R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone], n = 19; dose-adjusted R-EPOCH [rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin], n = 4) with median 6 cycles. Prior to RT, salvage ChT for refractory DLBCL was given to 43% (n = 10) and autologous stem cell transplantation was administered in 13% (n = 3). At the time of RT, positron emission tomography-CT revealed 5-point scale of 1 to 3 (48%; n = 11), 4 (9%; n = 2), and 5 (44%; n = 10). All patients received IMRT, daily CT imaging, and ISRT. The median RT dose was 40 Gy (range, 16.2-49.4 Gy). Relapse or progression occurred in 22% (n = 5). At a median follow-up of 37 months, the 3-year local control, PFS, and overall survival rates were 80%, 75%, and 96%, respectively. Among patients treated with RT after complete metabolic response to frontline ChT (n = 8), the 3-year PFS was 100%, compared with 61% for patients with a history of chemorefractory DLBCL (n = 15; P =.055). Four of the 5 relapses occurred in patients with 5-point scale of 5 prior to RT (P =.127). Conclusion: Mesenteric involvement of DLBCL can be successfully targeted with localized ISRT fields using IMRT and daily CT-image guidance.

Original languageEnglish (US)
Pages (from-to)e51-e61
JournalClinical Lymphoma, Myeloma and Leukemia
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Mesentery
Lymphoma, Large B-Cell, Diffuse
Radiotherapy
Disease-Free Survival
Tomography
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Recurrence
Drug Therapy
Stem Cell Transplantation
Etoposide
Survival Rate
Survival
Therapeutics

Keywords

  • Abdominal lymphoma
  • Chemorefractory
  • Five-point scale
  • Involved site radiation therapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

@article{eb32a5f6cd5e42249a51db542cf7d8b1,
title = "Hitting a Moving Target: Successful Management of Diffuse Large B-cell Lymphoma Involving the Mesentery With Volumetric Image-guided Intensity Modulated Radiation Therapy",
abstract = "Introduction: We report successful treatment of mesenteric diffuse large B-cell lymphoma (DLBCL) using localized involved site radiation therapy (ISRT), intensity modulated radiation therapy (IMRT), and daily computed tomography (CT)-image guidance. Patients and Methods: Patients with mesenteric DLBCL treated with RT between 2011 and 2017 were reviewed. Clinical and treatment characteristics were analyzed for an association with local control, progression-free survival (PFS), and overall survival. Results: Twenty-three patients were eligible. At diagnosis, the median age was 52 years (range, 38-76 years), and 57{\%} (n = 13) had stage I/II DLBCL. All patients received frontline chemotherapy (ChT) (R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone], n = 19; dose-adjusted R-EPOCH [rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin], n = 4) with median 6 cycles. Prior to RT, salvage ChT for refractory DLBCL was given to 43{\%} (n = 10) and autologous stem cell transplantation was administered in 13{\%} (n = 3). At the time of RT, positron emission tomography-CT revealed 5-point scale of 1 to 3 (48{\%}; n = 11), 4 (9{\%}; n = 2), and 5 (44{\%}; n = 10). All patients received IMRT, daily CT imaging, and ISRT. The median RT dose was 40 Gy (range, 16.2-49.4 Gy). Relapse or progression occurred in 22{\%} (n = 5). At a median follow-up of 37 months, the 3-year local control, PFS, and overall survival rates were 80{\%}, 75{\%}, and 96{\%}, respectively. Among patients treated with RT after complete metabolic response to frontline ChT (n = 8), the 3-year PFS was 100{\%}, compared with 61{\%} for patients with a history of chemorefractory DLBCL (n = 15; P =.055). Four of the 5 relapses occurred in patients with 5-point scale of 5 prior to RT (P =.127). Conclusion: Mesenteric involvement of DLBCL can be successfully targeted with localized ISRT fields using IMRT and daily CT-image guidance.",
keywords = "Abdominal lymphoma, Chemorefractory, Five-point scale, Involved site radiation therapy",
author = "Yoder, {Alison K.} and Jillian Gunther and Milgrom, {Sarah A} and Dragan Mirkovic and Loretta Nastoupil and Neelapu, {Sattva S} and Fanale, {Michelle A} and Nathan Fowler and Westin, {Jason Robert} and Lee, {Hun Ju} and Rodriguez, {Maria A} and Iyer, {Swaminathan Padmanabhan} and Fayad, {Luis E} and Yago Nieto and Chitra Hosing and Sairah Ahmed and Medeiros, {L Jeffrey} and Joseph Khoury and Naveen Garg and Behrang Amini and Dabaja, {Bouthaina Shbib} and Pinnix, {Chelsea Camille}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.clml.2018.09.002",
language = "English (US)",
volume = "19",
pages = "e51--e61",
journal = "Clinical Lymphoma, Myeloma and Leukemia",
issn = "2152-2669",
publisher = "Cancer Media Group",
number = "1",

}

TY - JOUR

T1 - Hitting a Moving Target

T2 - Successful Management of Diffuse Large B-cell Lymphoma Involving the Mesentery With Volumetric Image-guided Intensity Modulated Radiation Therapy

AU - Yoder, Alison K.

AU - Gunther, Jillian

AU - Milgrom, Sarah A

AU - Mirkovic, Dragan

AU - Nastoupil, Loretta

AU - Neelapu, Sattva S

AU - Fanale, Michelle A

AU - Fowler, Nathan

AU - Westin, Jason Robert

AU - Lee, Hun Ju

AU - Rodriguez, Maria A

AU - Iyer, Swaminathan Padmanabhan

AU - Fayad, Luis E

AU - Nieto, Yago

AU - Hosing, Chitra

AU - Ahmed, Sairah

AU - Medeiros, L Jeffrey

AU - Khoury, Joseph

AU - Garg, Naveen

AU - Amini, Behrang

AU - Dabaja, Bouthaina Shbib

AU - Pinnix, Chelsea Camille

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: We report successful treatment of mesenteric diffuse large B-cell lymphoma (DLBCL) using localized involved site radiation therapy (ISRT), intensity modulated radiation therapy (IMRT), and daily computed tomography (CT)-image guidance. Patients and Methods: Patients with mesenteric DLBCL treated with RT between 2011 and 2017 were reviewed. Clinical and treatment characteristics were analyzed for an association with local control, progression-free survival (PFS), and overall survival. Results: Twenty-three patients were eligible. At diagnosis, the median age was 52 years (range, 38-76 years), and 57% (n = 13) had stage I/II DLBCL. All patients received frontline chemotherapy (ChT) (R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone], n = 19; dose-adjusted R-EPOCH [rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin], n = 4) with median 6 cycles. Prior to RT, salvage ChT for refractory DLBCL was given to 43% (n = 10) and autologous stem cell transplantation was administered in 13% (n = 3). At the time of RT, positron emission tomography-CT revealed 5-point scale of 1 to 3 (48%; n = 11), 4 (9%; n = 2), and 5 (44%; n = 10). All patients received IMRT, daily CT imaging, and ISRT. The median RT dose was 40 Gy (range, 16.2-49.4 Gy). Relapse or progression occurred in 22% (n = 5). At a median follow-up of 37 months, the 3-year local control, PFS, and overall survival rates were 80%, 75%, and 96%, respectively. Among patients treated with RT after complete metabolic response to frontline ChT (n = 8), the 3-year PFS was 100%, compared with 61% for patients with a history of chemorefractory DLBCL (n = 15; P =.055). Four of the 5 relapses occurred in patients with 5-point scale of 5 prior to RT (P =.127). Conclusion: Mesenteric involvement of DLBCL can be successfully targeted with localized ISRT fields using IMRT and daily CT-image guidance.

AB - Introduction: We report successful treatment of mesenteric diffuse large B-cell lymphoma (DLBCL) using localized involved site radiation therapy (ISRT), intensity modulated radiation therapy (IMRT), and daily computed tomography (CT)-image guidance. Patients and Methods: Patients with mesenteric DLBCL treated with RT between 2011 and 2017 were reviewed. Clinical and treatment characteristics were analyzed for an association with local control, progression-free survival (PFS), and overall survival. Results: Twenty-three patients were eligible. At diagnosis, the median age was 52 years (range, 38-76 years), and 57% (n = 13) had stage I/II DLBCL. All patients received frontline chemotherapy (ChT) (R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone], n = 19; dose-adjusted R-EPOCH [rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin], n = 4) with median 6 cycles. Prior to RT, salvage ChT for refractory DLBCL was given to 43% (n = 10) and autologous stem cell transplantation was administered in 13% (n = 3). At the time of RT, positron emission tomography-CT revealed 5-point scale of 1 to 3 (48%; n = 11), 4 (9%; n = 2), and 5 (44%; n = 10). All patients received IMRT, daily CT imaging, and ISRT. The median RT dose was 40 Gy (range, 16.2-49.4 Gy). Relapse or progression occurred in 22% (n = 5). At a median follow-up of 37 months, the 3-year local control, PFS, and overall survival rates were 80%, 75%, and 96%, respectively. Among patients treated with RT after complete metabolic response to frontline ChT (n = 8), the 3-year PFS was 100%, compared with 61% for patients with a history of chemorefractory DLBCL (n = 15; P =.055). Four of the 5 relapses occurred in patients with 5-point scale of 5 prior to RT (P =.127). Conclusion: Mesenteric involvement of DLBCL can be successfully targeted with localized ISRT fields using IMRT and daily CT-image guidance.

KW - Abdominal lymphoma

KW - Chemorefractory

KW - Five-point scale

KW - Involved site radiation therapy

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UR - http://www.scopus.com/inward/citedby.url?scp=85055085840&partnerID=8YFLogxK

U2 - 10.1016/j.clml.2018.09.002

DO - 10.1016/j.clml.2018.09.002

M3 - Article

VL - 19

SP - e51-e61

JO - Clinical Lymphoma, Myeloma and Leukemia

JF - Clinical Lymphoma, Myeloma and Leukemia

SN - 2152-2669

IS - 1

ER -