Consolidation radiotherapy for advanced-stage aggressive B-cell non-Hodgkin lymphoma: A systematic review and meta-analysis

Authors

  • Ernie Yap Department of Medicine, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia
  • Zhe Kang Law Department of Medicine, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia
  • Nik Muhd Aslan Abdullah Department of Oncology, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia
  • S. Fadilah Abdul Wahid Department of Medicine, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia; Cell Therapy Centre, UKM Medical Centre (UKMMC), University Kebangsaan Malaysia (UKM)., Jalan Yaakob Latif, 56000, Kuala Lumpur, Malaysia

DOI:

https://doi.org/10.17179/excli2017-805

Keywords:

non-Hodgkin lymphoma, radiotherapy, aggressive B cell NHL, meta-analysis

Abstract

Patients with advanced aggressive B-cell non-Hodgkin lymphomas (NHL) are usually treated with rituximab in combination with chemotherapy. However, disease relapse rates are high. Radiotherapy (RT) has been shown to be efficacious in treating early-stage NHL but its role in advanced stage diseases is unclear. We performed a systematic review of randomized controlled trials (RCTs) comparing chemotherapy with RT to chemotherapy alone in patients with newly diagnosed advanced aggressive NHL. We searched online databases and pooled similar outcome estimates. For time-to-event outcomes, we estimated hazard ratios (HR) for overall survival (OS) and event-free survival (EFS) using the fixed-effect model. Two RCTs involving 254 patients met inclusion criteria. The trials were single-centre RCTs with follow-up period of five and ten years. Both trials were conducted in the pre-rituximab era. Patients treated with consolidation RT had better OS (HR for mortality 0.61; 95 % CI 0.38 to 0.97) and EFS (HR for mortality 0.67; 95 % CI 0.46 to 0.98) compared to those who received no RT. There was an apparent benefit of RT on local control (OR 0.09; 95 % CI 0.04 to 0.20); although this was estimated as a dichotomous rather than time-to-event outcome. Limited evidence shows benefits of consolidation RT in advanced aggressive NHL. However, we were not able to estimate the effect size with confidence due to small number of trials and sample size. We cannot recommend routine consolidation RT in advanced aggressive NHL. More RCTs with the inclusion of rituximab and PET-CT monitoring are needed.

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Published

2017-11-21

How to Cite

Yap, E., Law, Z. K., Aslan Abdullah, N. M., & Abdul Wahid, S. F. (2017). Consolidation radiotherapy for advanced-stage aggressive B-cell non-Hodgkin lymphoma: A systematic review and meta-analysis. EXCLI Journal, 16, 1233–1248. https://doi.org/10.17179/excli2017-805

Issue

Vol. 16 (2017)

Section

Review articles

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