ADJUVANT RADIOTHERAPY TO SITES OF PREVIOUS BULKY DISEASE IN PATIENTS STAGE-IV DIFFUSE LARGE-CELL LYMPHOMA

Purpose: To evaluate the usefulness of adjuvant radiotherapy to sites of previous bulky disease in patients with advanced diffuse large cell lymphoma (DLCL) who were in complete remission after chemotherapy. Me thods and Material: Two-hundred and eighteen patients were initially t reated with combined chemotherapy CEOP-bleo (cyclophosphamide, epirubi cin, vincristine, prednisone, bleomycin) alternating with DAC (dexamet hasone, cytosine arabinoside, and cisplatinum). One hundred and fifty- five patients achieved complete remission. Eighty-eight patients with initial bulky disease were randomly assigned to either received (43 pa tients) or not received radiotherapy (45 patients). Dose ranged from 4 0-50 Gy. Results: The median time to treatment failure has not been re ached in patients who received radiotherapy. At 5 years 72% of the pat ients treated with the combined therapy remain alive disease in free c ompared to only 35% in the control group. Projected survival at 5 year s was better in the patients with adjuvant radiotherapy: 81% compared to 55% in the patients who received no radiotherapy. Toxicity was mild and manageable. No lethal toxicities were observed. Conclusion: This treatment sequence produced durable control disease in patients with d isseminated DLCL and bulky disease with acceptable toxicity. The role of radiation therapy in patients with disseminated DLCL will be confir med in large clinical trials, but we felt that this sequence of treatm ent could be useful in patients with this clinical condition.