Journal article
Management Trends and Outcomes for Stage I to II Mantle Cell Lymphoma Using the National Cancer Data Base: Ascertaining the Ideal Treatment Paradigm
International journal of radiation oncology, biology, physics, v 93(3), pp 668-676
01 Nov 2015
PMID: 26461009
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose: Mantle cell lymphoma (MCL) is a rare, albeit aggressive subset of non-Hodgkin lymphoma, resulting in varied treatment approaches. Given the paucity of data defining the optimal management for early-stage MCL, we conducted an analysis using the National Cancer Data Base (NCDB) to identify practice patterns and outcomes.
Methods and Materials: The NCDB was queried for patients with stage I to II MCL diagnosed from 1998 to 2012 receiving chemotherapy (CT) or radiation therapy (RT), or both (CT+RT). Univariate and multivariable analyses for factors associated with treatment selection were completed using logistic regression. Propensity scores with inverse probability treatment weighting (IPTW) were calculated based on the conditional probability of receiving CT_RT. The log-rank test and Cox proportional hazards modeling with IPTW adjustment were conducted for the survival analyses.
Results: In total, 2539 patients were identified. The key characteristics were as follows: 69% were male, 71% were aged >= 60 years, 28% had extranodal involvement, and 51% had stage I disease. Of the 2539 patients, 70% underwent CT, 11% underwent RT, and 19% underwent CT+RT. The use of CT_RT decreased from 23.1% to 14.1% in 1998 to 2002 and 2010 to 2012 (P<.001). CT+RT usage was lower for patients with the following characteristics: age >= 60 years, female sex, stage II disease, and the presence of B symptoms. With a median follow-up period of 42.8 months, the unadjusted 3-year overall survival estimates for patients receiving CT, RT, or CT+RT were 67.8%, 72.4%, and 79.8%, respectively (P<.001). After correcting for indication bias through IPTW-adjusted modeling, CT+RT reduced the risk of overall mortality compared with monotherapy (hazard ratio 0.65, P=.029).
Conclusions: Although uncommon, patients with stage I-II MCL can have favorable outcomes. Despite a continued decline in the usage of consolidative RT, combined modality therapy improves survival in this cohort compared with monotherapy. (C) 2015 Elsevier Inc. All rights reserved.
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Details
- Title
- Management Trends and Outcomes for Stage I to II Mantle Cell Lymphoma Using the National Cancer Data Base: Ascertaining the Ideal Treatment Paradigm
- Creators
- Beant S. Gill - UPMC Hillman Cancer CenterJohn A. Vargo - UPMC Hillman Cancer CenterSarah S. Pai - University of Pittsburgh Medical CenterGoundappa K. Balasubramani - University of PittsburghSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- International journal of radiation oncology, biology, physics, v 93(3), pp 668-676
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000361879700024
- Scopus ID
- 2-s2.0-84942316495
- Other Identifier
- 991021897382904721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging