{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:43:43Z","timestamp":1789559023509,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2015,6,4]],"date-time":"2015-06-04T00:00:00Z","timestamp":1433376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2015,9,15]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Despite international practice guidelines endorsing radiotherapy (RT) as the preferred initial therapy, treatment approaches vary for patients with early\u2010stage follicular lymphoma. The authors engaged the National Cancer Data Base to analyze patterns of care and survival outcomes for patients with early\u2010stage follicular lymphoma in the era of modern therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A National Cancer Data Base retrospective cohort study was conducted of 35,961 patients with lymph node and extranodal, American Joint Committee on Cancer stage I to II, WHO grade 1 to 2 follicular lymphoma who were diagnosed between 1998 and 2012. Univariate and multivariable analyses were performed to identify sociodemographic, treatment, and tumor characteristics that were predictive of overall survival (OS) and treatment use. Propensity score\u2010adjusted Cox proportional hazards ratios for survival in patients treated for follicular lymphoma were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Of the 35,961 patients with follicular lymphoma included in the current study, 63% had stage I disease, 79% were without extranodal disease, and 61% were aged &gt;60 years. RT use decreased from 37% in 1999 to 24% in 2012 (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.0001), with corresponding significant increases in observation and single\u2010agent chemotherapy. Patients who received RT had 5\u2010year and 10\u2010year OS rates of 86% and 68%, respectively, compared with 74% and 54%, respectively, for those who did not receive RT (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.0001). On multivariable survival analysis, including a propensity score to account for potential uncaptured confounding variables due to a lack of randomization, upfront RT remained independently associated with improved OS (hazard ratio of death, 0.54; 95% confidence interval, 0.47\u20100.63 [\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.0001]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>\n                      RT is an increasingly underused treatment approach in the era of modern therapy for patients with early\u2010stage follicular lymphoma. The use of RT appears to improve OS and should remain standard practice as encouraged by clinical practice guidelines.\n                      <jats:bold>\n                        <jats:italic>Cancer<\/jats:italic>\n                        2015;121:3325\u20133334.\n                      <\/jats:bold>\n                      \u00a9\n                      <jats:italic>2015 American Cancer Society<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.29491","type":"journal-article","created":{"date-parts":[[2015,6,4]],"date-time":"2015-06-04T14:05:41Z","timestamp":1433426741000},"page":"3325-3334","source":"Crossref","is-referenced-by-count":61,"title":["What is the optimal management of early\u2010stage low\u2010grade follicular lymphoma in the modern era?"],"prefix":"10.1002","volume":"121","author":[{"given":"John A.","family":"Vargo","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beant S.","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goundappa K.","family":"Balasubramani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Epidemiology Data Center University of Pittsburgh Graduate School of Public Health Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushil","family":"Beriwal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.4.1282"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1994.213"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"6521","DOI":"10.1200\/jco.2004.22.90140.6521","article-title":"Long\u2010term outcome in stage I and II follicular lymphoma following treatment with involved field radiation therapy alone","volume":"22","author":"Petersen PM","year":"2004","journal-title":"J Clin Oncol."},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-8140(95)01600-L"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25149"},{"key":"e_1_2_7_7_1","unstructured":"National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Non\u2010Hodgkin's Lymphoma. 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