Unfortunately, treatment toxicity was not well-documented and thus could not be analyzed. The differences in radiation treatment planning are likely the result of the wide study period (1998-2017), during which involved-site RT became available. There was also heterogeneity in regard to treatment, as patients received differing numbers of chemoimmunotherapy cycles and different radiation planning approaches. Potential limitations of a retrospective design include selection bias, information bias, and changes to disease classification and management during the wide study period, as well as a heterogenous cohort. Furthermore, due to the retrospective nature of this study, there are multiple resulting limitations. On MVA when controlling for NCCN IPI and presence or absence of extranodal disease, receipt of RT (hazard ratio, 0.4 95% CI, 0.2-0.8 P = .01) was significantly associated with improved OS.Īlthough our analysis reached statistical significance for our stated primary outcome, there were insufficient cases eligible for analysis to show valid differences among various subgroups. In patients with intermediate-high to high IPI, 5-year OS with consolidative RT was 58% (95% CI, 23%-82%) compared with 25% (95% CI, 8%-47%) for those treated with chemoimmunotherapy alone. Ten-year OS in this group was 79% (95% CI, 56%-91%) with consolidative RT versus 71% (95% CI, 55%-82%) with chemoimmunotherapy alone. In patients with low to low-intermediate IPI, the 5-year OS with consolidative RT was 97% (95% CI, 79%-99%), compared with 80% (95% CI, 66%-89%) for those treated with chemoimmunotherapy alone. On UVA, consolidative RT was associated with improved OS for patients with intermediate-high to high IPI (log-rank P = .04) but not for patients with low to low-intermediate IPI (log-rank P = .30). Ten-year OS was 67% versus 58% ( Fig 2), numerically higher for those treated with consolidative RT. The 5-year OS for those treated with consolidative RT was 87% (95% CI, 72%-94%), compared with 67% (95% CI, 54%-77%) for those treated with chemoimmunotherapy alone. OS was numerically higher among those receiving consolidative RT compared with chemoimmunotherapy alone, but the difference was not statistically significant (log-rank P = .16, Fig 2). Ten (9%) patients had bony involvement at diagnosis. Of the patients who received consolidative RT, 52% were treated with involved-field RT, while the remaining 48% received involved-site RT. The median RT dose in the consolidative group was 36 Gy (20-45 Gy, Q1-Q3 30.6-39.6 Gy). Maximal average dimensions of tumor were 6.0 cm (1.8-20 cm) versus 6.2 cm (0.9-21 cm) in the consolidation RT versus chemoimmunotherapy alone cohorts, respectively. This was the only prognostic factor that correlated with receipt of RT patients with worse PS were more likely to receive RT, as determined by the Fisher exact test ( P <. However, ECOG PS was 0 to 1 in 87% versus 59% in the chemoimmunotherapy alone versus consolidation RT groups, respectively. The mean age, stage, presence of bony or bulky disease, B symptoms, NCCN IPI score, and extranodal involvement were well-balanced between the groups in this analysis. Seventy-seven (65%) patients received chemoimmunotherapy alone and 41 (35%) received chemoimmunotherapy followed by consolidative RT. A total of 118 patients meeting the previously mentioned eligibility criteria were included in the analysis. A summary of patient characteristics in the cohort examined can be found in Table 1.
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