To report the clinical findings and long-term results of front-line, third-generation MACOP-B (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin) chemotherapy and mediastinal involved-field radiotherapy (IFRT) in 85 consecutive, previously untreated patients with primary mediastinal large B cell lymphoma (PMLBCL) diagnosed and managed at a single institution.Between 1991 and April 2004, 92 consecutive, untreated patients with PMLBCL were treated at our institution. The median age was 33 years (range, 15-61 years), 46 patients (50\%) showed a mediastinal syndrome at onset; 52 patients (57\%) showed a low/low-intermediate (0 to 1) and 40 patients (43\%) an intermediate-high/high (2 to 3) International Prognostic Index (IPI) score. Eighty-five patients were treated with standard chemotherapy (MACOP-B), and 80 underwent mediastinal IFRT at a dose of 30-36 Gy.After a MACOP-B regimen, the overall response rate was 87\% and the partial response rate 9\%. After chemotherapy, (67)Ga scintigraphy/positron emission tomography results were positive in 43 of 52 patients (83\%), whereas after IFRT 11 of 52 patients (21\%) remained positive (p < 0.0001). After a median follow-up of 81 months (range, 2-196 months), progression or relapse was observed in 15 of 84 patients (18\%). The projected 5-year overall survival and progression-free survival rates were 87\% and 81\%, respectively. The 5-year overall survival and progression-free survival rates were better for patients with an IPI of 0 to 1 than for those with an IPI of 2 to 3 (96\% vs. 73\% [p = 0.002] and 90\% vs. 67\% [p = 0.007], respectively).Combined-modality treatment with intensive chemotherapy plus mediastinal IFRT induces high response and lymphoma-free survival rates. Involved-field RT plays an important role in inducing negative results on (67)Ga scintigraphy/positron emission tomography in patients responsive to chemotherapy.
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|Titolo:||MACOP-B and involved-field radiotherapy is an effective and safe therapy for primary mediastinal large B cell lymphoma.|
|Data di pubblicazione:||2008|
|Appartiene alla tipologia:||01a Articolo in rivista|