Overall survival of patients with nodal non-Hodgkin's lymphomas of the abdominal cavity and pelvis after chemoradiotherapy and chemotherapy.

Abstract

Relevance. There are no publications in the available literature on the results of treatment of patients with primary nodal non-Hodgkin's lymphomas of abdominal and pelvic localization.Purpose of research. Comparative evaluation of the effectiveness of chemoradiotherapy (CRT) and chemotherapy (CT) in the patients with primary nodal non-Hodgkin lymphomas of abdominal and pelvic localization by the criterion of the overall survival (OS).

Materials and methods. 208 patients with nodal non-Hodgkin lymphomas of abdominal and pelvic localization were retrospectively studied: 111 patients (the main group) underwent chemoradiotherapy (chemotherapy + adjuvant radiation therapy), 97 patients (the control group) received chemotherapy (CT) according to similar generally accepted schemes. The OS of the patients of the main and the control groups as a whole, as well as the subgroups with different demographic and clinical parameters were analyzed: the gender, the age, the somatic status (Karnovsky index - KI), the degree of the malignancy of lymphoma, the localization of lymphoma, the stage of the disease, size of the primary focus, the prognostic groups, the immediate effect of chemotherapy (complete remission, partial remission, stabilization). The patients with refractory disease were not included in the study.

Results. In general, for the compared groups, 10-year OS rates were statistically significantly higher in the CRT group (51.7% vs 27.5%, P=0.002), including: in the men (59.0% vs 28.7%, P=0.005), in the  patients 60 years and older (51.3% vs 26.5%, P=0.011), with KI 90-80 (65.4% vs 27.2%, P=0.015), KI 70-60 (49.1% vs 27.5%, P= 0.037), at the stages I-II (85.0% vs 57.0%, P=0.044), III-IV stages (47.8% vs 19.5%, P=0.013), the tumor size of 10 cm or more (49.5% vs 22.0%, p=0.006), as well as in the patients with indolent lymphomas (55.4% vs 21.0%, P=0.01), with primary lesion of abdominal lymph nodes (47,0% vs 27,8%, p=0,042), the high-risk patients (61.7% vs 18.0%, P=0.009), the patients with the partial remission/stabilization after CT (51.3% vs 11.6%, P=0.0000..). In the patients with alternative values of the analyzed parameters, the increase in OS in the CRT group was close to significant (P=0.07-0.13). In the patients treated with Rituximab, 10-year OS was also statistically significantly higher in the CRT group (78.9% vs 26.3%, P=0.0003). Only in the patients with chemotherapy-induced complete remission and in the patients with B-cell lymphomas treated without Rituximab, the 10-year OS did not differ significantly in the main and control groups (75.2% vs 56.1%, P=0.569 and 41,8% vs 28,8%, Р=0,196). In the multivariate regression analysis, the treatment program turned out to be the most significant parameter affecting the OS (P=0.0007).

Conclusion. Compared with chemotherapy, the chemoradiotherapy program statistically significantly or at a close to significant level increases the overall survival of the most patients with nodal non-Hodgkin's lymphomas of abdominal and pelvic localization, with the exception of a cohort of patients with the complete remission achieved after frontline chemotherapy and the patients with B-cell lymphomas who did not receive Rituximab. The maximal values of OS were achieved with a combination of the frontline chemotherapy with Rituximab and the adjuvant radiation therapy.