ABSTRACT
@#High-Grade B-Cell Lymphoma (HGBCL) with gene rearrangements in MYC and BCL2 and/or BCL6 is an aggressive malignancy usually presenting in advanced stages. Current recommendations suggest the use of regimens more intensive than R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone), which are based on retrospective studies and single-arm prospective trials that included patients who are mostly in the advanced stage, and did not receive consolidation radiotherapy. The optimal approach and treatment of HGBCL, whether limited-stage (LS) or advanced-stage, remains to be determined. Here we describe the promising outcomes of three patients with LS and low IPI HGBCL with the use of R-CHOP as induction chemotherapy regimen, which was followed by consolidation radiotherapy. Three women, 54-, 60-, and 64-years of age diagnosed to have HGBCL with MYC, and BCL2 and/or BCL6 rearrangements, with Ann Arbor stages I-IIE were included in this case series. All three patients had complete metabolic response to 6 cycles of R-CHOP and was subsequently treated with consolidation involved site radiotherapy (ISRT; total dose 30-36 Gy). Chemotherapy and radiotherapy were tolerated very well. All patients remain to be in remission, with the longest being at 23 months. Outcomes of patients with HGBCL generally remain to be poor, but this may not be the case for patients with limited-stage disease and favorable clinicopathologic risk profile. Nevertheless, the treatment of HGBCL is currently evolving and more studies are needed to determine the ideal approach and preferred chemotherapy regimen. Also, more studies are needed to elucidate the potential role of consolidation radiotherapy in patients with limited-stage HGBCL to improve survival outcomes. Findings of this case series suggest that patients with LS HGBCL may still derive benefit from R-CHOP followed by consolidation ISRT, but prospective trials are needed to confirm this.
ABSTRACT
Background@#Delays in initiation and interruptions in the radiotherapeutic management of head and neck malignancies have radiobiologic implications in allowing for the accelerated repopulation of surviving tumor cells. This phenomenon has been demonstrated to translate into poorer survival outcomes and tumor control, typically manifesting as tumor progression that may require a new radiotherapy set-up. Such adjustments are accounted for with a repeat computed tomography (CT) simulation which entails increased resource costs, patient inconvenience and further treatment delays. Even with maximal efforts to minimize treatment delays, the real-world effects of the current pandemic on the logistics and compliance to daily radiotherapy remain significant. A comparison of the incidence of tumor progression before and during the pandemic is thus investigated, with repeat CT simulation utilized as a surrogate. @*Objective@#This study aims to compare the incidence of repeat CT simulation among patients with head and neck cancer treated before and during the COVID-19 pandemic. Various patient- and/or treatment-related factors, including treatment delay, that may associate with the likelihood of repeat simulation are also investigated in this review. @*Methods@#Medical and radiation treatment records of patients with head and neck malignancies who underwent CT simulation before and during the pandemic were retrospectively reviewed and prospectively followed up until completion of treatment. @*Results@#A total of 72 patients were included, with an average age of 45 years (range: 7–82). The median time to radiotherapy initiation was 37 days (SD ± 37, range of 0–278) from initial CT simulation and was similar between the groups (p = 0.774). Repeat simulation was observed more frequently in the pandemic group (76.2% vs 23.8%, p = 0.007). Patients who had delayed radiotherapy initiation (p = 0.005, OR 13.59; CI 2.23–82.87) or had treatment interruptions (p = 0.004, OR 23.21; CI 2.79–193.29) had a higher incidence of repeat simulation. @*Conclusion@#A higher incidence of repeat simulation was observed in this population treated six months into the pandemic. Delays in radiotherapy initiation and treatment interruptions were significantly associated with repeat simulation. Strategies should be employed to prevent disease progression among this subset of patients to minimize the burden on radiotherapy resources and preserve oncologic outcomes.