Primary Mediastinal B cell Lymphoma in the Positron-Emission Tomography Era Executive Summary of the American Radium SocietyTM Appropriate Use Criteria. International journal of radiation oncology, biology, physics Hoppe, B. S., Advani, R., Milgrom, S. A., Bakst, R. L., Ballas, L. K., Dabaja, B. S., Flowers, C. R., Ha, C. S., Mansur, D. B., Metzger, M. L., Pinnix, C. C., Plastaras, J. P., Roberts, K. B., Smith, S. M., Terezakis, S. A., Kirwan, J. M., Constine, L. S. 2021


BARCKGROUND: Primary mediastinal B cell lymphoma(PMBCL) is a highly curable subtype of non-Hodgkin lymphoma that is predominantly diagnosed in adolescents and young adults. Consequently, long-term treatment-related morbidity is critical to consider when devising treatment strategies that include different chemoimmunotherapy strategies with or without radiotherapy. Furthermore, adaptive approaches using the end-of-chemotherapy (EOC)positron emission tomography (PET)/computed tomography (CT) scanning may help determine which patients may benefit from additional therapies. We aimed to develop evidence-based guidelines for treating these patients.METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guideline using PubMed database. The ARS expert committee made up of radiation oncologists, hematoligists, and pediatric oncologists developed consensus guidelines using the modifited DELPHI framework.RESULTS: Nine studies were identified that met the full criteria for inclusion based on reporting outcomes on patients with primary mediastinal B cell lymphoma with EOC PET/CT response scored with the 5 point Deauville scale. These studies formed the evidence for these guidelines in managing patients with PMBCL according to the EOC PET response, including after a 5PDS of 1-3, 4, 5, and for patients with relapsed and refractory disease. The expert group also developed guidance on radiation simulation, treatment planning, and plan evaluation based on expert opinion.CONCLUSIONS: Various treatment approaches exist in the management of PMBCL, including different chemoimmunotherapy regimens, the use of consolidative radiotherapy, and adaptive approaches based on EOC PET/CT response. These guidelines can be used by practitioners to provide appropriate treatment according to different disease scenarios.

View details for DOI 10.1016/j.ijrobp.2021.03.035

View details for PubMedID 33774076