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Using Deauville Scoring to Guide Consolidative Radiotherapy in Diffuse Large B-Cell Lymphoma
by
, , , , ,
Chun En Yau
1,†
,
Chen Ee Low
1,†,
Whee Sze Ong
2,
Lay Poh Khoo
3,
Joshua Tian Ming Hoe
3,
Ya Hwee Tan
3,
Esther Wei Yin Chang
3,
Valerie Shiwen Yang
3,4,
Eileen Yi Ling Poon
3,4,
Jason Yongsheng Chan
3,4,
Iris Huili Sin
5,
Kheng Wei Yeoh
5,
Nagavalli Somasundaram
3,4,
Mohamed Farid Bin Harunal Rashid
3,4,
Miriam Tao
3,4,
Soon Thye Lim
3,4 and
Jianbang Chiang
3,4,* 1
Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
2
Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
3
Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
4
Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore 169857, Singapore
5
Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work and share first-authorship.
Cancers 2024, 16(19), 3311; https://doi.org/10.3390/cancers16193311
Submission received: 24 August 2024
/
Revised: 17 September 2024
/
Accepted: 24 September 2024
/
Published: 27 September 2024
(This article belongs to the Special Issue New Insights of Hematology in Cancer)
Simple Summary
This study aims to evaluate the role of end-of-treatment PET-CT scans, interpreted using the Deauville score (DV), in guiding the use of consolidative radiotherapy (RT) for DLBCL patients. The goal is to help avoid unnecessary RT for low-risk patients, as current guidelines are unclear, potentially leading to the overuse of RT. We analyzed the data of 349 patients and RT was associated with a significant improvement in time-to-progression amongst the DV4-5 patients but not the DV1-3 patients. Our data suggest that DLBCL patients with end-of-treatment PET-CT DV1-3 may not require consolidative RT.
Abstract
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’s p = 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’s p = 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.
Keywords:
PET-CT; DLBCL; consolidative treatment; de-escalation; radiotherapy
