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

Sze Wei Yap, Zhe Kang Law, Nik Muhd. Aslan Abdullah, S Fadilah S. Abdul Wahid

Research output: Contribution to journalReview article

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1233-1248
Number of pages16
JournalEXCLI Journal
Volume16
DOIs
Publication statusPublished - 21 Nov 2017

Fingerprint

non-Hodgkin lymphoma
systematic review
B-Cell Lymphoma
radiotherapy
meta-analysis
Non-Hodgkin's Lymphoma
B-lymphocytes
Meta-Analysis
Radiotherapy
Randomized Controlled Trials
drug therapy
Disease-Free Survival
Drug Therapy
Survival
Mortality
relapse
Combination Drug Therapy
Sample Size
Databases
Recurrence

Keywords

  • Aggressive B cell NHL
  • Meta-analysis
  • Non-hodgkin lymphoma
  • Radiotherapy

ASJC Scopus subject areas

  • Molecular Medicine
  • Animal Science and Zoology
  • Pharmacology
  • Drug Discovery

Cite this

Consolidation radiotherapy for advanced-stage aggressive B-cell non-hodgkin lymphoma : A systematic review and meta-analysis. / Yap, Sze Wei; Law, Zhe Kang; Abdullah, Nik Muhd. Aslan; S. Abdul Wahid, S Fadilah.

In: EXCLI Journal, Vol. 16, 21.11.2017, p. 1233-1248.

Research output: Contribution to journalReview article

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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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