Chemotherapy with or without radiotherapy in limited stage aggressive non hodgkin's Lumphoma

ABSTRACT

To compare the efficacy, toxicity and clinical out come in patients with limited-stage aggressive nondgkin's lymphoma treated with eight cycles of chemotherapy alone or four to six cycles of chemotherapy plus involved field irradiation. One hundred patients with limited aggressive non-Hodgkin's lymphoma were randomly signed to either eight cycles of CHOP alone or four to six cycles of CHOP plus involved-field radiotherapy. The end point were response rate, toxic effects, disease-free survival d overall survival Patients treated with four to six cycles of CHOP is radiotherapy had significantly better disease-free survival in patients treated with CHOP alone. The five-year estimates disease-free survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were,6% and 65.1%, respectively [p=0.041]. The five-year imates of overall survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were%and 70%, respectively [p=0.160]. Complete response eswere experienced in 92% in patients treated with CHOP is radiotherapy and 86% in patients treated with CHOP me [p=0.338]. Relapse in original site of disease was significantly higher in patients treated with CHOP alone 9% vs 6.5% in patients treated with CHOP plus radiotherapy =0.007. However, there was no statistically significant difference in systemic relapse between patients treated with CHOP alone [13.9%] and patients treated with CHOP plus radiotherapy [15.2%] [p=0.866]. The adverse effects included a treatment-related deaths in patients treated with eight cycles of CHOP alone versus no treatment-related deaths in ients treated with CHOP plus radiotherapy [p=0.239]. Life threatening toxic effects grade 3,4 neutropenia were recorded 20% in patients treated with CHOP plus radiotherapy versus% in patients treated with eight cycles of CHOP alone p=0.048, symptoms and signs of congestive heart failure rerecorded in two patients treated with eight cycles of IOP alone, but in no patients treated with CHOP plus iotherapy. For subgroups identified using the Miller modification of the International prognostic Index [IP1], the 5 year disease-free survival and overall survival were signifi-Itly influenced by the number of risk factors in both treat-pt groups [CHOP alone p=0.006, p=0.043 and CHOP plus btherapy p<0.001, p=0.0/3, respectively]. Pour to six cycles of CHOP followed by involved field-radiotherapy are superior to eight cycles of CHOP alone for the treatment of localized aggressive non-Hodgkin's lymphoma. Patients who attained complete response after CHOP plus radiotherapy had more prolonged disease-free survival and higher local control than in patients treated with CHOP alone. IPI risk group was found to be the only significant predictor of overall survival and disease-free survival in both treatment groups.