Proceedings of the 51st Annual ASTRO Meeting S483

2669 Preliminary Results of Concurrent Chemoradiation Therapy in Patients with Early Stage Extranodal

Nasal Type NK/T-cell Lymphoma

Y. Yang, Y. J. Zhang, Z. Y. He, Y. H. Gao, H. Q. Huang, X. X. Guan, T. Y. Lin, Y. F. Xia

1. State Key Laboratory of Oncology in Southern China, 2. Department of Radiation Oncology, 3. Department of MedicalOncology, Cancer center, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China, Guangzhou, China

Purpose/Objective(s): Extranodal nasal type NK/T-cell lymphoma (ENKTCL) is a peculiar pathological type of NHL withhigher incidence in south China. Though most of the diseases can be diagnosed at early stage, the prognosis after combinedradiotherapy (RT) and chemotherapy (CT) is generally poor, and optimal treatments remain unclear. We investigated concur-rent chemoradiation therapy (CCRT) in a group of patients and here report the feasibility and preliminary outcome of thistreatment.

Materials/Methods: 15 patients with diagnoses of early stage ENKTCL were treated with CCRT in our hospital from Feb, 1996through Dec, 2006. There were 12 males and 3 females, aged 28–63 years (median 41 years). 13 patients were with Ann ArborStage IE disease, and 2 with Stage IIE, and B symptoms were identified in 8 of the 15 patients. Primary tumors invaded nasal cavityand paranasal sinus (12 patients), nasopharynx (2 patients), or both (1 patient). International Prognostic Index (IPI) scores were 0 in12 patients and 1 in 3 patients. In treatment, 5 patients received induction CT + CCRT + sequential CT, 7 patients received induc-tion CT followed by CCRT, 1 patients received CCRT and sequential CT, and 2 patients received CCRT alone. The RT doses inCCRT were DT 46–66 Gy (median 54 Gy) in conventional fractionations. For local control (LC) and survival comparisons, 125consecutive patients with early stage ENKTCL and comparable clinical features were analyzed as control group, who receivedsequential CT and RT during the same period.

Results: Overall remission (CR+PR) rate after induction CT and completion of CCRT were 41.6% and 100%, respectively.Grade 3 or 4 bone marrow suppression was observed in 4 (26.7%) patients. 2 (13.3%) patients developed Grade 3 oral muco-sitis. 1 (6.7%) patient developed Grade 3 sore throat, and the remaining adverse events were all Grade 1 to 2. The follow-updurations were 10–75 months(median 35.4 months)for the CCRT patients. The actuarial 1-, 3-, and 5-years overall survival(OS) rates were 86.7%, 78.8%, and 65.7%, respectively. All the primary tumors got locally controlled during follow-up,and the LC rate in 125 controlled cases was 78.4%(chi-square = 4.01, p = 0.045). The difference between the 5-years OSwas not significant (51.9% vs. 65.7%, chi-square = 1.64, p = 0.201),the 5-years progress-free survival (PFS) rate showed bor-derline significant improvement than that of the 125 patients treated with sequential CT and RT (41.0% vs. 65.7%, chi-square=3.67, p=0.055).

Conclusions: According to literature review, this is the largest cohort of clinical report in the world on CCRT in patients with earlystage ENKTCL. This preliminary result demonstrates that CCRT may be an effective treatment improvement for early stageENKTCL, and its toxicity can be tolerated.

Author Disclosure: Y. Yang, None; Y.J. Zhang, None; Z.Y. He, None; Y.H. Gao, None; H.Q. Huang, None; X.X. Guan, None;T.Y. Lin, None; Y.F. Xia, None.

2670 Early Stage Large B-cell Lymphoma in the Rituximab-CHOP +/- Radiation Era: Tailored Therapy

Provides Excellent Outcome

S. Dhakal1, M. Sikder2, J. Kelly3, S. H. Bernstein2, F. M. Young2, R. I. Fisher2, J. W. Friedberg2, L. S. Constine1

1Department of Radiation Oncology, University of Rochester, Rochester, NY, 2Department of Hematology/Oncology,University of Rochester, Rochester, NY, 3Department of Community & Preventive Medicine, University of Rochester,Rochester, NY

Purpose/Objective(s): The role of consolidative radiation therapy (RT) after chemotherapy in treatment of patients with earlystage diffuse large B-cell lymphoma (DLBCL) has not been defined in the rituximab (R) era. We evaluated baseline characteristicsand outcomes of patients with early stage DLBCL treated at our institution with R-CHOP followed by RT (R-CHOP+RT) or R-CHOP alone to define variables that may guide treatment selection.

Materials/Methods: 48 consecutive patients with early stage DLBCL diagnosed 6/2001–5/2006 who received primary treatmentwith R-CHOP were evaluated. Event free survival (EFS) and overall survival (OS) were estimated using Kaplan-Meier survivalmethods.

Results: 5 patients had primary refractory (PRef) disease and thus were not eligible for consolidative RT. 25 patients re-ceived involved field RT (median 36 Gy, range, 30.6–46.8) after R-CHOP (median 4 cycles exclusive of patients withprimary testicular or mediastinal lymphoma) while 18 patients received R-CHOP alone (median 7 cycles). Median age(years) was 57 for R-CHOP+RT and 53 for R-CHOP, but 70 for PRef. Males comprised 76% of R-CHOP+RT, 56%of R-CHOP, and 100% of PRef. B symptoms were less frequent in R-CHOP+RT (12%) compared with R-CHOP(39%) and PRef (40%), while bulky disease was similar in R-CHOP+RT and R-CHOP (16% and 17%), but more commonin PRef (60%). Most R-CHOP+RT had Stage I disease (68%), while most R-CHOP (78%) and all PRef patients had StageII disease. Extranodal disease was similar in frequency amongst groups. Mean stage adjusted International PrognosticIndex (IPI) was 1.8 for both R-CHOP+RT and R-CHOP but 2.6 for PRef. At a mean follow-up of 4.5 years (range,2.1–7.5), overall EFS was 83% and OS was 86%. There were no relapses and one cardiac death in R-CHOP+RT, 3 re-lapses and one death secondary to disease progression in R-CHOP, and 4 deaths in PRef (plus 1 in remission after salvagetherapy).

Conclusions: In a consecutive series of early stage DLBCL patients selected for treatment with R-CHOP followed by RT or R-CHOP alone, EFS and OS were uniformly excellent (despite a higher mean and range of IPI scores compared with publisheddata). The few refractory patients had (on average) an even higher IPI, thus confirming its prognostic utility. Our study sug-gests that future trials in the rituximab era should focus on secondary outcomes, such as cardiac toxicity, secondary malignan-cies, and quality of life, recognizing that the choice of RT versus additional chemotherapy may depend on presenting patientand disease characteristics. Additionally, an evaluation of immunohistochemical and molecular markers (in process) may yield

S484 I. J. Radiation Oncology d Biology d Physics Volume 75, Number 3, Supplement, 2009

data that could help identify the subset of patients who fair relatively poorly and thus justify a different initial treatmentstrategy.

Author Disclosure: S. Dhakal, None; M. Sikder, None; J. Kelly, None; S.H. Bernstein, None; F.M. Young, None; R.I. Fisher,None; J.W. Friedberg, None; L.S. Constine, None.

2671 Radiation Therapy for Primary Mucosa-associated Lymphoid Tissue (MALT) Lymphoma of the Orbit

M. Hata, I. Ogino, M. Omura, I. Koike, S. Kurihara, Y. Tayama, K. Odagiri, Y. Minagawa, T. Inoue

Yokohama City University Graduate School of Medicine, Yokohama, Japan

Purpose/Objective(s): Among extranodal lymphomas, orbital lymphoma is a relatively rare presentation. Its most common his-tological subtype is a marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). Orbital MALT lymphoma isusually indolent and shows slow growth, but the mass effect due to tumor growth frequently induces proptosis and visual disorders.We carried out a review to ascertain treatment efficacy and toxicity of radiation therapy in primary MALT lymphoma of the orbit.We also evaluated changes in visual acuity after irradiation.

Materials/Methods: Thirty patients, 16 men and 14 women, 37 to 87 years of age (median, 64 years) at irradiation, with primaryMALT lymphoma of the orbit underwent radiation therapy with curative intent. Clinical stages at diagnosis were Stage IE in 26patients and Stage IIE in 4; 3 of these 4 had tumors in both eyes, the other had cervical lymph node metastasis. No patients had Bsymptoms such as fever, body weight loss, or night sweats. A total dose of 28.8–45.8 Gy (median, 30.3 Gy) in 15–26 fractions(median, 16 fractions) was delivered to the tumors using 4–6 MV X-rays or 5–20 MeV electrons.

Results: All irradiated tumors, including primary orbital tumors and cervical lymph node metastasis, were controlled during thefollow-up periods of 5–151 months (median, 34 months) after treatment. Only one patient had recurrence, which arose in the ip-silateral palpebral conjunctiva outside the radiation field at 5.5 years after treatment. The progression-free rate at 5 years was 100%.All thirty patients are presently alive; the overall and progression-free survival rates at 5 years were each 100%. Although 6 patientsdeveloped cataracts after irradiation, they underwent an intraocular lens implantation and recovered their sight. As well, there wasno deterioration in the visual acuity of all but these patients with cataracts. No other therapy-related severe toxicity was observed.

Conclusions: Radiation therapy was effective and safe for patients with primary MALT lymphoma of the orbit. Though somepatients contracted cataracts after irradiation, visual acuity was well preserved.

Author Disclosure: M. Hata, None; I. Ogino, None; M. Omura, None; I. Koike, None; S. Kurihara, None; Y. Tayama, None; K.Odagiri, None; Y. Minagawa, None; T. Inoue, None.

2672 The Results of Radiotherapy for Primary Ocular Adnexal Malt Lymphoma

S. Ohga

Department of Clinical Radiology, Kyushu University Hospital, Fukuoka, Japan

Purpose/Objective(s): To evaluate the treatment outcome of radiotherapy for primary ocular adnexal mucosa-associated lym-phoid tissue (MALT) lymphoma.

Materials/Methods: Between 1995 and 2008, 53 patients were treated with the radiotherapy for the primary ocular adnexalMALT lymphoma. Patient age ranged from 22 to 87 years (median: 62 years). Initial clinical stage according to the Ann Arborstaging system. was IA: in 45 and IIA in: 8. The sites of tumor were orbita in 28, conjunctiva in 19 and lacrimal gland in 6. Per-formance status were 0 in 35 and 1 in 18, respectively. The superficial lesions were treated with 24 Gy/12 F, but mass lesions with30 Gy/20 F.

Results: The duration of follow-up was 8 to 162 months (median: 47 months). The rates of complete response and partial responsewere 39.6% and 58.5%, respectively. Locally relapse was observed in one patient, and distant relapse developed in four patients.All relapsed patients have mass lesions. There was no diseae-related death. The 5-year survival rates of freedom from systemic andlocal relapse were 91.5% and 97%, respectively. Grade 3 cataract were observed in eleven patients and Grade 2 dry eye in sixteenpatients. No other severe toxicities were observed.

Conclusions: The radiation dose of 24–30 Gy for ocular adnexual MALT lymphoma was the safe and effective. Especially, 24 Gywas the enough dose for the superficial lesion.

Author Disclosure: S. Ohga, None.

2673 Determining Patterns of Therapy Choice in Patients Treated for Early Stage, Aggressive Histology Non-

Hodgkin’s Lymphoma

A. Swaminath, T. Kouroukis, S. Voruganti, S. Sagar, D. Marcellus, A. Benger, R. Foley, M. Trus, G. Fraser, J. Sussman

Juravinski Cancer Centre, Hamilton, ON, Canada

Purpose/Objective(s): Variation exists in the management of early stage, aggressive histology non-Hodgkin’s lymphoma (NHL).An analysis was therefore undertaken in a large centre to describe patterns of practice, as well as outcomes in this group of patients.

Materials/Methods: From 1994 to 2004, 147 patients with Stage 1/2, aggressive histology (by WHO criteria) NHL were retro-spectively reviewed. Pertinent prognostic data were extracted. Overall survival (OS) and progression-free survival (PFS) were cal-culated using Kaplan-Meier methods. Influences of various factors on treatment modality were cross-tabulated and calculated usingchi-square analysis.