Treatment results of radiotherapy following CHOP or R-CHOP in limited-stage head-and-neck diffuse large B-cell lymphoma: a single institutional experience

  • Jeong, Jae-Uk (Department of Radiation Oncology, Chonnam National University Hwasun Hospital) ;
  • Chung, Woong-Ki (Department of Radiation Oncology, Chonnam National University Hwasun Hospital) ;
  • Nam, Taek-Keun (Department of Radiation Oncology, Chonnam National University Hwasun Hospital) ;
  • Yang, Deok-Hwan (Department of Hematology-Oncology, Chonnam National University Hwasun Hospital) ;
  • Ahn, Sung-Ja (Department of Radiation Oncology, Chonnam National University Hwasun Hospital) ;
  • Song, Ju-Young (Department of Radiation Oncology, Chonnam National University Hwasun Hospital) ;
  • Yoon, Mee Sun (Department of Radiation Oncology, Chonnam National University Hwasun Hospital) ;
  • Kim, Yong-Hyeob (Department of Radiation Oncology, Chonnam National University Hwasun Hospital)
  • Received : 2017.09.08
  • Accepted : 2017.10.31
  • Published : 2017.12.31


Purpose: This study evaluated outcomes of radiotherapy (RT) after chemotherapy in limited-stage head-and-neck diffuse large B-cell lymphoma (DLBCL). Materials and Methods: Eighty patients who were treated for limited-stage head-and-neck DLBCL with CHOP (n = 43) or R-CHOP (n = 37), were analyzed. After chemotherapy, RT was administered to the extended field (n = 60) or the involved field (n = 16), or the involved site (n = 4). The median dose of RT ranged from 36 Gy in case of those with a complete response, to 45-60 Gy in those with a partial response. Results: In all patients, the 5-year overall survival (OS) and disease-free survival (DFS) rates were 83.9% and 80.1%, respectively. In comparison with the CHOP regimen, the R-CHOP regimen showed a better 5-year DFS (86.5% vs. 73.9%, p = 0.027) and a lower rate of treatment failures (25.6% vs. 8.1%, p = 0.040). The volume (p = 0.047) and dose of RT (p < 0.001) were significantly reduced in patients treated with R-CHOP compared to that in those treated with CHOP. Conclusion: The outcomes of RT after chemotherapy with R-CHOP were better than those of CHOP regimen for limited-stage head-and-neck DLBCL. In patients treated with R-CHOP, a reduced RT dose and volume might be feasible without increasing treatment failures.


  1. Jung KW, Won YJ, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 2015;47:127-41.
  2. Yu JI, Nam H, Ahn YC, Kim WS, Park K, Kim SJ. Involved-lesion radiation therapy after chemotherapy in limited-stage headand-neck diffuse large B cell lymphoma. Int J Radiat Oncol Biol Phys 2010;78:507-12.
  3. Campbell BA, Connors JM, Gascoyne RD, Morris WJ, Pickles T, Sehn LH. Limited-stage diffuse large B-cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy: involved-field versus involved-node radiotherapy. Cancer 2012;118:4156-65.
  4. Krol AD, Berenschot HW, Doekharan D, Henzen-Logmans S, van der Holt B, van 't Veer MB. Cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy and radiotherapy for stage I intermediate or high grade non-Hodgkin's lymphomas: results of a strategy that adapts radiotherapy dose to the response after chemotherapy. Radiother Oncol 2001;58:251-5.
  5. Lowry L, Smith P, Qian W, et al. Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: a randomised phase III trial. Radiother Oncol 2011;100:86-92.
  6. Yahalom J, Illidge T, Specht L, et al. Modern radiation therapy for extranodal lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2015;92:11-31.
  7. Feugier P, Van Hoof A, Sebban C, et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol 2005;23:4117-26.
  8. Pfreundschuh M, Trumper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-Bcell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 2006;7:379-91.
  9. Pfreundschuh M, Schubert J, Ziepert M, et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 2008;9:105-16.
  10. Rosenberg SA. Validity of the Ann Arbor staging classification for the non-Hodgkin's lymphomas. Cancer Treat Rep 1977;61:1023-7.
  11. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007;25:579-86.
  12. Miller TP, Dahlberg S, Cassady JR, et al. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med 1998;339:21-6.
  13. Horning SJ, Weller E, Kim K, et al. Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkin's lymphoma: Eastern Cooperative Oncology Group study 1484. J Clin Oncol 2004;22:3032-8.
  14. Phan J, Mazloom A, Medeiros LJ, et al. Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy. J Clin Oncol 2010;28:4170-6.
  15. Kwon J, Kim IH, Kim BH, Kim TM, Heo DS. Additional survival benefit of involved-lesion radiation therapy after R-CHOP chemotherapy in limited stage diffuse large B-cell lymphoma. Int J Radiat Oncol Biol Phys 2015;92:91-8.
  16. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; c2011 [cited 2017 Nov 27]. Available from:
  17. Kaplan HS. Hodgkin's disease: unfolding concepts concerning its nature, management and prognosis. Cancer 1980;45:2439-74.<2439::AID-CNCR2820451003>3.0.CO;2-1
  18. Nathu RM, Mendenhall NP, Almasri NM, Lynch JW. Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. Head Neck 1999;21:247-54.<247::AID-HED10>3.0.CO;2-6
  19. Verhappen MH, Poortmans PM, Raaijmakers E, Raemaekers JM. Reduction of the treated volume to involved node radiation therapy as part of combined modality treatment for early stage aggressive non-Hodgkin's lymphoma. Radiother Oncol 2013;109:133-9.
  20. Wilder RB, Tucker SL, Ha CS, et al. Dose-response analysis for radiotherapy delivered to patients with intermediategrade and large-cell immunoblastic lymphomas that have completely responded to CHOP-based induction chemotherapy. Int J Radiat Oncol Biol Phys 2001;49:17-22.