CHOP chemotherapy (ct) with rituximab and radiotherapy (RT) as a first line treatment for aggressive non-Hodgkin's lymphoma (NHL)-our experience

Abstract

Background: In advanced aggressive NHC CT is a basic treatment. Additional involved-field RT may achieve a better outcome. Aims: In this study we combined two modalities of treatment (CHOP regimen with monoclonal antibody rituximab and RT) and assessed their role. Material and Methods: We treated 40 patients (pts) with advanced aggressive NHL initially with the CHOP regimen plus rituximab. There were 26 male and 14 female, median age was 53 years (range 43-68), with stage III or IV disease. RT was given to 16 (40%) of pts. Indication for RT included initial bulky disease and lack of complete remission (CR) after CT, involved-field RT was used with one fraction per day of 1.8 Gy, to a total dose delivered by 19-22 fractions. Response was assessed at two months after the end of RT and the every three months. The primary end point was freedom from progression (FFP) and overall survival (OS) after 3 years. Median observation time was 26 months. Results: The rate of complete remission (CR) was 60% after CT. Following RT the rates of CR and PR were 81% and 19%, respectively. Three-year FFP and OS in pts who received RT were 71% and 79%, respectively. In pts who were treated with CHOP+rituximab alone 3-year FFP and OS were 52% and 61.5%, respectively. Univariant analysis showed that stage, extranodal involvement, performance status, LDH level, are significant prognostic factors for survival. Conclusion: Combination of these two modalities CT and RT showed better outcome as a first-line treatment for pts with advances aggressive NHL, the applied CT alone.