{"doi":"10.21203/rs.3.rs-137697/v1","title":"Improved Progression-Free Survival for Bulky and Non-Bulky Advanced Stage Diffuse Large B-Cell Lymphoma with Consolidative Radiation Therapy: A Bi-Institutional Analysis","abstract":"<jats:title>Abstract</jats:title>\n        <jats:p>Background: The role of consolidative radiation therapy (RT) for advanced stage diffuse large B-cell lymphoma (DLBCL) is not fully established. Retrospective data provide evidence for the use of consolidative RT in stage III-IV DLBCL and emerging data from randomized studies address the role of RT in bulky disease for these patients.Methods: Patient with stage III-IV DLBCL treated at two institutions who achieved clinical complete response to systemic therapy were included. Kaplan-Meier analysis was performed to determine the impact of consolidative RT. Univariate and multivariable analyses were performed using a Cox proportional hazards model.Results: One hundred eighty-eight patients received systemic therapy consisting of R-CHOP (79%), another Rituximab-based regimen (9%), or chemotherapy alone (12%). Clinical response was assessed using conventional CT or PET-CT. Sixty-eight patients (36%) received consolidative RT (median dose 30 Gy). Consolidative RT conferred a 36.7% absolute benefit in five-year progression-free survival (85.9% vs. 49.2%, log rank p &lt; 0.0001), and a 14.5% absolute benefit in five-year overall survival (87.4% vs. 72.9%, log rank p = 0.0134). On multivariable analysis, consolidative RT was associated with improved PFS (HR 0.23, 95% CI 0.10-0.52, p &lt; 0.001). Patients receiving consolidative RT demonstrated significantly improved PFS for tumors measuring both &lt;5 cm (log rank p = 0.0454) and ³5 cm (log rank p = 0.0003).Conclusions: For patients with stage III-IV DLBCL who achieve clinical complete response after systemic therapy, consolidative RT improves PFS for all patients, including those with non-bulky disease. This benefit persists in the setting of rituximab-based systemic therapy.</jats:p>","journal":"Research Square (Research Square)","year":null,"id":16764,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":122491,"name":"Cecilia Jiang","orcid":null,"position":1,"is_corresponding":false},{"id":122492,"name":"Jeffrey Switchenko","orcid":null,"position":2,"is_corresponding":false},{"id":122493,"name":"Khadija Kirmani","orcid":null,"position":3,"is_corresponding":false},{"id":122494,"name":"Chris Kelsey","orcid":null,"position":4,"is_corresponding":false},{"id":122495,"name":"Mohammad K Khan","orcid":null,"position":5,"is_corresponding":false},{"id":122490,"name":"Yusef Ali Syed","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36284789","pmcid":null,"openalex_id":"https://openalex.org/W4238526866","authors":[],"funders":[{"funder_name":"National Institutes of Health","grant_id":"5P30CA138292-11","title":"Winship Cancer Institute Cancer Center Support Grant"},{"funder_name":"National Institutes of Health","grant_id":"5R01HL105643-04","title":"Early Detection of Changes in Pulmonary Gas Exchange by Hyperpolarized  Xe MRI"},{"funder_name":"National Institutes of Health","grant_id":"5R01CA201212-03","title":"Developing knowledge models to enable rapid learning in radiation therapy"},{"funder_name":"National Centre for the Replacement, Refinement and Reduction of Animals in Research","grant_id":"NC/P001076/1","title":null},{"funder_name":"Biotechnology and Biological Sciences Research Council","grant_id":"BBS/E/T/000PR9817","title":null},{"funder_name":"Wellcome Trust","grant_id":"209558/Z/17/Z","title":null},{"funder_name":"HCRW_","grant_id":"RFPPB-18-1497(T)","title":null},{"funder_name":"Medical Research Council","grant_id":"MR/S036954/1","title":null},{"funder_name":"Medical Research Council","grant_id":"MR/K010468/1","title":null}],"total_grants":9,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[],"oa_status":"green","license":"cc-by","oa_locations":[{"url":"https://www.researchsquare.com/article/rs-137697/v1.pdf?c=1631884313000","host_type":"repository"},{"url":"https://www.researchsquare.com/article/rs-137697/v1.pdf?c=1631884313000","host_type":"repository"},{"url":"https://www.researchsquare.com/article/rs-137697/v1","host_type":"publisher"},{"url":"https://www.researchsquare.com/article/rs-137697/v1.html","host_type":"publisher"},{"url":"https://doi.org/10.21203/rs.3.rs-137697/v1","host_type":"repository"},{"url":"https://doi.org/10.7759/cureus.17107","host_type":""},{"url":"https://www.cureus.com/articles/61498-improved-progression-free-survival-for-bulky-and-non-bulky-advanced-stage-diffuse-large-b-cell-lymphoma-with-consolidative-radiation-therapy-a-bi-institutional-analysis.pdf","host_type":""},{"url":"https://europepmc.org/articles/pmc8432970?pdf=render","host_type":""},{"url":"https://pubmed.ncbi.nlm.nih.gov/34527492","host_type":""},{"url":"http://dx.doi.org/10.7759/cureus.17107","host_type":""},{"url":"https://dx.doi.org/10.7759/cureus.17107","host_type":""}],"fields_of_study":["Lymphoma Diagnosis and Treatment","CAR-T cell therapy research","CNS Lymphoma Diagnosis and Treatment","03 medical and health sciences","0302 clinical medicine"],"mesh_terms":[],"keywords":["Diffuse large B-cell lymphoma","Stage (stratigraphy)","Log-rank test","Univariate analysis","Progression-free survival","Radiation therapy","Internal medicine","Medicine","Regimen","Rituximab","Oncology","Proportional hazards model","Survival analysis","Lymphoma","Systemic therapy","Multivariate analysis","Chemotherapy","Nuclear medicine","Cancer","Biology","Radiation Oncology","carotid-cavernous fistula","endoscopy","endovascular treatment","transsphenoidal surgery","video"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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