2021 CSCO Professor Li Yexiong talks about the important role of radiotherapy in the treatment of indolent lymphoma

On September 25-29, 2021, the 24th National Conference on Clinical Oncology and the 2021 CSCO Annual Conference will be held in a combination of online and offline
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At the meeting, Professor Li Yexiong from the Department of Radiation Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences gave a report on "Radiotherapy of Early Indolent Lymphoma"
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Yimaitong organized the main content as follows for readers .

 Indolent lymphomas are mainly divided into extranodal mucosa-associated lymphoma (MALT) lymphoma and follicular lymphoma (FL), both of which rarely have mediastinal lymph node invasion.
MALT lymphomas account for 60-90% of stage I-II, high The malignant transformation rate is less than 10%; while the FL Ⅰ-II stage accounts for 20%, and the high-grade malignant transformation rate is 10%-30%
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The median age of onset of indolent lymphoma is greater than 60 years, and patients are at higher risk of dying from other diseases, so their overall survival (OS) rate is often underestimated
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Later, Professor Li emphasized that for early indolent lymphomas, including early low-grade B-cell lymphoma (stage I-II MALT lymphoma and FL), early skin low-grade lymphoma (limited-stage FL, anaplastic large cell lymphoma) Tumor [ALCL] and mycosis fungoides [MF]) and chemotherapy-resistant or intolerable early Hodgkin’s lymphoma (HL), radiotherapy is a radical treatment, radiotherapy can make most patients with early indolent lymphoma The 5-year OS rate is over 95%
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The effect of radiotherapy on early MALT lymphoma and FL 1 Early MALT lymphoma The 5-year OS rate of any treatment for MALT lymphoma can reach more than 95% at present, but the use rate of early MALT lymphoma radiotherapy is less than 50%, Professor Li The reasons for this include concerns about the long-term toxicity of radiotherapy, increasing the risk of dying from other diseases in elderly patients, and so on
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In this regard, Professor Li said that the survival analysis of MALT lymphoma should consider the net treatment benefit, and correct the risk of dying from other diseases due to advanced age and other reasons.
It is recommended to use reasonable observation indicators, including standardized death ratio (SMR) and relative survival.
(RS) and 10 years of OS rate
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Next, Professor Li introduced the effect of radiotherapy on MALT lymphoma.
The researchers calculated the survival status of 185 patients with stage I gastric MALT who received radiotherapy and 162 patients who received chemotherapy from the SEER database from 1997 to 2007.
Among them, the patients who received radiotherapy The 5-year lymphoma-related mortality rate is much smaller than that of chemotherapy patients, which proves that for these patients, radiotherapy is better than chemotherapy
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In addition, some researchers analyzed 7774 patients with stage I-II MALT lymphoma in the SEER database from 1998 to 2010 and found that the 5-year lymphoma-related mortality of patients receiving radiotherapy was significantly lower than that of patients without radiotherapy
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The researchers analyzed the SEER database of patients with stage I gastric MALT lymphoma from 1993 to 2014 and found that the 5-year OS rate and 5-year disease-specific survival (DSS) rate of patients receiving radiotherapy were higher than those of patients in the chemotherapy group
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In addition, Professor Li’s team analyzed 9467 patients with stage I-II MALT lymphoma in the SEER database from 2000 to 2015, and it also preliminarily confirmed that radiotherapy has good survival benefits and lower mortality compared with other treatments (the study The results have not yet been published)
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Based on the above research, Professor Li said that for early extranodal MALT lymphoma, radiotherapy alone is the standard treatment
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2 Early FL Next, Professor Li introduced the researcher's data analysis results of 6568 patients with I-II stage I-II FL in the SEER database from 1973 to 2003.
Among them, 34% of the patients received the first course of radiotherapy.
The results showed Compared with patients who did not receive radiotherapy, the survival time of patients receiving radiotherapy was significantly prolonged.
In contrast, according to the analysis of 35961 patients with I-II stage I-II FL in the NCDB database from 1998 to 2012, chemotherapy Did not improve the survival rate of early FL patients
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But this does not mean that chemotherapy has no effect on early FL patients.
According to the TROG 99.
03 clinical trial, compared with radiotherapy alone, radiotherapy combined with chemotherapy can significantly improve the progression-free survival (PFS) of patients, and there is no difference in 10-year OS rate
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Therefore, for early FL, Professor Li said that radiotherapy ± chemotherapy is the standard treatment
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Lymphoma radiotherapy dose and side effects Professor Li said that the radiation volume of low-grade lymphoma is affected field radiotherapy (ISRT), the radical radiation dose is 24-30Gy, and the palliative radiation dose is 2×2Gy
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Speaking of the side effects of radiotherapy for lymphoma, Professor Li said that early radical radiotherapy for HL, due to its wide area and high dose, has the risk of inducing second primary tumors and cardiovascular death, but now the conditions for radiotherapy have been greatly improved.
And a large sample showed that radiotherapy did not increase the risk of non-Hodgkin’s lymphoma (NHL) as the second primary tumor
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Professor Li Yexiong, associate professor, Ph.
D.
, doctoral supervisor, Director of Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences ) Chairman of the Radiotherapy Special Committee, Beijing Medical Association Radiation Oncology Branch, Designated Chairman, International Lymphoma Radiotherapy Collaboration Group (ILROG) Standing Committee Member of the New Century Ten Thousand Thousand Talent Project, National Candidate, Ministry of Health, Outstanding Contribution, Young and Middle-aged Expert Wu Jieping-Paul· There are more than 350 papers of the Janssen Medical Pharmacy Award, more than 150 SCI papers, more than 600 points of total impact factor (IF) for correspondence or first author, 18 papers> 10 points (10 papers> 20, 6 papers> 30, 4 papers> 40) Poke "read the original text", we make progress together