Session Item

Saturday
May 07
16:55 - 17:55
Auditorium 15
Haematology
Jessica Brady, United Kingdom;
Lena Specht, Denmark
1560
Proffered Papers
Clinical
17:35 - 17:45
The role of radiation therapy in the treatment of primary hepatic lymphomas
Jennifer Ma, USA
OC-0296

Abstract

The role of radiation therapy in the treatment of primary hepatic lymphomas
Authors:

Jennifer Ma1, Remy Daou2, Josiane Bou Eid2, Jisun Lee1, Beatrice Fregonese1, Joe El-Khoury2, N. Ari Wijetunga1, Harper Hubbeling1, Kathryn Tringale1, Emily Lebow1, Brandon Imber1, Joachim Yahalom1, Carla Hajj1

1Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, USA; 2Saint Joseph University of Beirut, Family Medicine, Beirut, Lebanon

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Purpose or Objective

Primary hepatic lymphomas (PHL) are an extremely rare form of non-Hodgkin Lymphoma (NHL) for which there are no established treatment guidelines, with available literature largely comprised of small case reports. Therefore, we evaluate our institutional experience treating PHL within the context of existing literature to better understand treatment modalities, role of radiotherapy (RT), and outcomes.

Material and Methods

We conducted a single institutional retrospective analysis of all PHL patients (pts) diagnosed from 2000-2021 with a biopsy-proven liver lesion without other lymphomatous solid organ involvement, except for concurrently diagnosed splenic lymphomas. Subgroup analysis was performed for diffuse large B-cell lymphoma (DLBCL) and indolent lymphomas, which included marginal zone (MZL), follicular (FL), and low-grade B-cell lymphoma (BCL), NOS. Univariable (UVA) and multivariable analysis (MVA) for overall survival (OS) was performed using the Cox proportional hazards model. A literature review was conducted using key words “liver”, “lymphoma”, and “treatment.”

Results

We identified 30 PHL pts within the institutional cohort and 192 pts from comprehensive literature review (Table 1). DLBCL subgroup analysis (n=15) with UVA for OS is listed in Table 2. On MVA for OS, only ECOG score (p=0.02) and Lugano stage (p=0.04) remained significant. Indolent lymphoma subgroup analysis (n=9) with UVA for OS is listed in Table 2 and Figure 1. On MVA for OS, only age remained significant. 

Variable

Institutional Cohort (n=30)
N (%)

Literature Review (n=192)
N (%)

Gender
     Male
     Female
     Unknown


16 (53)
14 (47)
-


98 (51)
76 (40)
18 (9)

Risk Factors
     Smoking
     Hepatitis C
     Hepatitis B
     Autoimmune Conditions


10 (33)
3 (10)
2 (7)
4 (13)


-
31 (16)
32 (17)
16 (8)

Symptoms at Presentation
     Incidental Finding
     Abdominal Pain
     Weight Loss
     Jaundice


9 (30)
8 (27)
6 (20)
3 (10)


47 (24)
60 (31)
31 (16)
16 (8)
ECOG
     0
     1
     2

25 (83)
3 (10)
2 (7)
-

Lugano Staging
     I
     II
     III
     IV


25 (83)
-
3 (10)
2 (7)


187 (97)
2 (1)
-
3 (2)

Bulky Disease6 (20)1 (0.5)
Nodal Involvement3 (10)5 (3)
Treatment Modality
     Systemic Therapy
     Surgery
     Radiation
     Observation

20 (67)
4 (13)
4 (13)
4 (13)


96 (50)
69 (36)
10 (5)
11 (6)

Vital Status
     Alive
     Dead
     Lost to Follow-up


17 (57)
8 (27)
5 (17)

97 (51)
36 (19)
3 (2)
Median Follow-up (years)62

Table 1. Patient characteristics for institutional and literature review cohorts.


Table 2. Patient characteristics for institutional and literature review cohorts with UVA for OS, by subtype. 

Conclusion

PHLs are a rare subtype of NHL without clear treatment consensus. Primary hepatic DLBCL appears to be treated primarily with chemotherapy with adequate disease control. For indolent PHL, low-dose RT appears to achieve good disease control with minimal toxicity. Our RT data is limited by short follow-up duration of RT pts compared to pts who received chemotherapy, surgery or observation. However, our results are encouraging for the use of RT for appropriate patients with indolent PHL.