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Abstract：
Bulky and residual tumor are considered to increase the risk of relapse in diffuse large B-cell lymphoma (DLBCL) patients. Radiotherapy is conventionally used to reduce the risk, but the evidence is controversial. We performed a retrospective analysis to evaluate the significance of bulky and residual tumor treated with or without radiotherapy in DLBCL patients. We analyzed 312 DLBCL patients treated from 2010-2017 in Oulu University Hospital. A bulky tumor was detected in 123 patients and 55 of these patients (44.3%) received consolidative radiation therapy (RT) to the bulky tumor. Residual tumor meeting the required criteria was found in 138 (39.3%) patients, and 65 (45.5%) of these patients received consolidative RT to the site of residual tumor. iPET-CT scans were performed in 102 patients. In multivariate analyses, bulky was an independent risk factor in limited stage patients in progression free survival (HR 6.43 [95%CI 1.609-25.710]; P = .008) not related to International prognostic index (HR 1.35 [95% CI 0.256-7.124]; P = .724) or age (HR 1.62 [95% CI 0.468-5.638]; P = .445). This was not seen in advanced stage patients or in patients with residual tumor. Radiotherapy to the bulky or residual tumor was not able to improve the long-term PFS of patients. In this study, it appears that performing iPET is the most convincing method in improving evaluation and in finding patients with increased risk of relapse. Evidently, patients with negative iPET will not benefit from including RT in the treatment after metabolic complete response (CR), and patients with primary refractory disease are most likely in the group of positive iPET.
摘要：
大体积和残余肿瘤被认为增加了弥漫性大B细胞淋巴瘤（DLBCL）患者的复发风险。放射疗法通常用于降低风险，但证据是有争议的.我们进行了回顾性分析，以评估DLBCL患者接受或不接受放疗治疗的大体积和残留肿瘤的意义。我们分析了奥卢大学医院2010-2017年治疗的312例DLBCL患者。在123例患者中检测到大肿瘤，其中55例（44.3％）接受了大肿瘤的巩固放射治疗（RT）。在138例（39.3%）患者中发现了符合规定标准的残留肿瘤，这些患者中有65例（45.5％）在残留肿瘤部位接受了巩固性RT。对102例患者进行了iPET-CT扫描。在多变量分析中，在无进展生存期(HR6.43[95CI1.609-25.710];P=.008)和国际预后指数(HR1.35[95%CI0.256-7.124];P=.724)或年龄(HR1.62[95%CI0.468-5.638];P=.445)不相关的局限期患者中,大体积是独立的危险因素.在晚期患者或残留肿瘤患者中未发现这种情况。对大体积或残留肿瘤的放射治疗不能改善患者的长期PFS。在这项研究中,在改善评估和发现复发风险增加的患者方面,进行iPET似乎是最有说服力的方法.显然,iPET阴性的患者在代谢完全反应（CR）后将无法从治疗中包括RT中受益，在iPET阳性组中，原发难治性疾病患者最可能。
