Originally published as JCO Early Release 10.1200/JCO.2006.07.0722 on January 16 2007

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CHOP Alone Compared With CHOP Plus Radiotherapy for Localized Aggressive Lymphoma in Elderly Patients: A Study by the Groupe d’Etude des Lymphomes de l’Adulte

Christophe Bonnet, Georges Fillet, Nicolas Mounier, Gérard Ganem, Thierry Jo Molina, Catherine Thiéblemont, Christophe Fermé, Bruno Quesnel, Claude Martin, Christian Gisselbrecht, Hervé Tilly, Félix Reyes

From the Centre Hospitalier Universitaire, Université de Liège, Liège, Belgium; Hôpital Saint-Louis, Assistance Publique; Hôpital Hôtel-Dieu, Assistance Publique, Hôpitaux de Paris, Paris; Clinique Victor Hugo, Le Mans; Centre Hospitalier Lyon Sud, Pierre-Bénite; Institut Gustave Roussy, Villejuif; Centre Hospitalier Universitaire de Lille; Centre Hospitalier Général, Annecy; Centre Henri Becquerel, Rouen; and Hôpital Henri Mondor, Assistance Publique, Hôpitaux de Paris; Créteil, France

Address reprint requests to Georges Fillet, MD, University of Liege, Centre Hospitalier Universitaire–Sart Tilman, Avenue de l'Hôpital, 13, Liège 4000, Belgium; email: g.fillet{at}ulg.ac.be

Purpose: Chemoradiotherapy has been considered standard treatment for patients with limited-stage aggressive lymphoma on the basis of trials conducted before the introduction of the International Prognostic Index. To evaluate this approach in elderly patients with low-risk localized lymphoma, we conducted a trial comparing chemoradiotherapy with chemotherapy alone.

Patients and Methods: Previously untreated patients older than 60 years with localized stage I or II histologically aggressive lymphoma and no adverse prognostic factors of the International Prognostic Index were randomly assigned to receive either four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus involved-field radiotherapy (299 patients) or chemotherapy alone with four cycles of CHOP (277 patients).

Results: With a median follow-up time of 7 years, event-free and overall survival did not differ between the two treatment groups (P = .6 and P = .5, respectively). The 5-year estimates of event-free survival were 61% for patients receiving chemotherapy alone and 64% for patients receiving CHOP plus radiotherapy; the 5-year estimates of overall survival were 72% and 68%, respectively. In a multivariate analysis, overall survival was affected by stage II disease (P < .001) and male sex (P = .03).

Conclusion: In this large prospective study, CHOP plus radiotherapy did not provide any advantage over CHOP alone for the treatment of low-risk localized aggressive lymphoma in elderly patients.

published online ahead of print at www.jco.org on January 16, 2007.

Deceased.

Supported by Grant No. AOM95061 from the Programme Hospitalier de Recherche Clinique du Ministère de la Santé and in part by grants from Amgen, Thousand Oaks, CA, and Roche, Basel, Switzerland.

Presented in part at the 47th Annual Meeting of the American Society of Hematology, December 10-13, 2005, Atlanta, GA.

Both C.B. and G.F. contributed equally to this study.

This article is dedicated to the memory of Félix Reyes, chairman of the LNH-93 program and president of the Groupe d'Etude des Lymphomes de l'Adulte.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Editorial

• Role of Radiation Therapy in Localized Aggressive Lymphoma
  Andrea K. Ng and Peter M. Mauch
  JCO 2007 25: 757-759 [Full Text]

Related Correspondence

• How Can We Determine the Role of Radiotherapy in the Treatment of Localized Aggressive Non-Hodgkin's Lymphoma?
  Cengiz Gemici and Taflan Salepci
  JCO 2007 25: 2857 [Full Text]

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