Background: The most common aggressive lymphoma in adults is diffuse large B-cell lymphoma (DLBCL). Consolidative radiotherapy (RT) is often administered to DLBCL patients but guidelines remain unclear, which could lead to unnecessary RT. We aimed to evaluate the value of end-of-treatment PET-CT scans, interpreted using the Deauville score (DV), to guide the utilization of consolidative RT, which may help spare low-risk DLBCL patients from unnecessary RT. Methods: We included all DLBCL patients diagnosed between 2010 and 2022 at the National Cancer Centre Singapore with DV measured at the end of the first-line chemoimmunotherapy. The outcome measure was time-to-progression (TTP). The predictive value of DV for RT was assessed based on the interaction effect between the receipt of RT and DV in Cox regression models. Results: The data of 349 patients were analyzed. The median follow-up time was 38.1 months (interquartile range 34.0–42.3 months). RT was associated with a significant improvement in TTP amongst the DV4-5 patients (HR 0.33; 95%CI 0.13–0.88;p= 0.027) but not the DV1-3 patients (HR 0.85; 95%CI 0.40–1.81;p= 0.671) (interaction’sp= 0.133). Multivariable analysis reported that RT was again significantly associated with improved TTP among the DV4-5 patients (adjusted HR 0.29; 95%CI 0.10–0.80;p= 0.017) but not the DV1-3 group (HR 0.86; 95%CI 0.40–1.86;p= 0.707) (interaction’sp= 0.087). Conclusion: Our results suggests that DLBCL patients with end-of-treatment PET-CT DV1-3 may not need consolidative RT. Longer follow-up and prospective randomized trials are still necessary to investigate long-term outcomes.
背景：弥漫性大B细胞淋巴瘤（DLBCL）是成人中最常见的侵袭性淋巴瘤。巩固性放疗（RT）常被用于DLBCL患者，但相关指南尚不明确，可能导致不必要的放疗。本研究旨在评估基于Deauville评分（DV）判读的疗程结束时PET-CT扫描对指导巩固性放疗的应用价值，以期帮助低风险DLBCL患者避免不必要的放疗。方法：我们纳入了2010年至2022年间在新加坡国立癌症中心确诊的所有DLBCL患者，这些患者均在一线化学免疫治疗结束时进行了DV评估。主要结局指标为疾病进展时间（TTP）。通过Cox回归模型中放疗接受情况与DV评分之间的交互效应，评估DV对放疗的预测价值。结果：共分析349例患者数据。中位随访时间为38.1个月（四分位距34.0-42.3个月）。在DV4-5分患者中，放疗与TTP显著改善相关（HR 0.33；95%CI 0.13-0.88；p=0.027），而在DV1-3分患者中则无显著关联（HR 0.85；95%CI 0.40-1.81；p=0.671）（交互作用p=0.133）。多变量分析显示，在DV4-5分患者中放疗仍与TTP改善显著相关（校正后HR 0.29；95%CI 0.10-0.80；p=0.017），但在DV1-3分组中无显著关联（HR 0.86；95%CI 0.40-1.86；p=0.707）（交互作用p=0.087）。结论：研究结果表明，疗程结束时PET-CT评分为DV1-3分的DLBCL患者可能无需进行巩固性放疗。仍需更长期的随访和前瞻性随机试验来验证长期结局。
Using Deauville Scoring to Guide Consolidative Radiotherapy in Diffuse Large B-Cell Lymphoma
肿瘤(癌症)患者之家