{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:27:22Z","timestamp":1790468842439,"version":"4.1.0"},"reference-count":28,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"29","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2018,10,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Follicular lymphoma (FL) is curable by involved-field radiotherapy (IFRT) in &lt; 50% of patients with stage I to II disease. We hypothesized that adding systemic therapy to IFRT would improve long-term progression-free survival (PFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>\n                      A multicenter randomized controlled trial enrolled patients with stage I to II low-grade FL after staging computed tomography scans and bone marrow biopsies.\n                      <jats:sup>18<\/jats:sup>\n                      F-labeled fluorodeoxyglucose\u2013positron emission tomography (PET) was not mandatory. Patients were randomly assigned to either arm A (30 Gy IFRT alone) or arm B (IFRT plus six cycles of cyclophosphamide, vincristine, and prednisolone [CVP]). From 2006, rituximab was added to arm B (R-CVP).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2000 and 2012, 150 patients were enrolled, 75 per arm. In arm B, 44 patients were allocated to receive CVP and 31 were allocated to receive R-CVP. At randomization, 75% had stage I, the median age was 57 years, 52% were male, and 48% were PET staged. With a median follow-up of 9.6 years (range, 3.1 to 15.8 years), PFS was superior in arm B (hazard ratio, 0.57; 95% CI, 0.34 to 0.95; P = .033). Ten-year PFS rates were 59% (95% CI, 46% to 74%) and 41% (95% CI, 30% to 57%) for arms B and A, respectively. Patients in arm B who received R-CVP had markedly superior PFS compared with contemporaneous patients in arm A (hazard ratio, 0.26; 95% CI, 0.07 to 0.97; P = .045). Fewer involved regions ( P = .047) and PET staging ( P = .056) were associated with better PFS. Histologic transformation occurred in four and 10 patients in arms B and A, respectively ( P = .1). Ten deaths occurred in arm A versus five in arm B, but overall survival was not significantly different ( P = .40; 87% and 95% at 10 years, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Systemic therapy with R-CVP after IFRT reduced relapse outside radiation fields and significantly improved PFS. IFRT followed by immunochemotherapy is more effective than IFRT in early-stage FL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.2018.77.9892","type":"journal-article","created":{"date-parts":[[2018,7,5]],"date-time":"2018-07-05T15:55:23Z","timestamp":1530806123000},"page":"2918-2925","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":114,"title":["Randomized Trial of Systemic Therapy After Involved-Field Radiotherapy in Patients With Early-Stage Follicular Lymphoma: TROG 99.03"],"prefix":"10.1200","volume":"36","author":[{"given":"Michael","family":"MacManus","sequence":"first","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Fisher","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Roos","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Macann","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidney","family":"Davis","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Tsang","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Christie","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bev","family":"McClure","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Joseph","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayasingham","family":"Jayamohan","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Seymour","sequence":"additional","affiliation":[{"name":"Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O\u2019Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2004.09.001"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/hon.882"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8588(05)70469-X"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.4.1282"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25117"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S0936-6555(89)80009-3"},{"key":"B7","first-page":"1129","volume":"61","author":"Bush RS","year":"1977","journal-title":"Cancer Treat Rep"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(84)90028-2"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(98)00233-8"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2013.07.013"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.07.111"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.annonc.a010543"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-08-3175"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(99)00559-3"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(95)00060-C"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/BF02990087"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19830701)52:1<1::AID-CNCR2820520102>3.0.CO;2-M"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19930401)71:7<2342::AID-CNCR2820710728>3.0.CO;2-I"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(80)90027-9"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70036-1"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2011.05.013"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.09.051"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.13.5376"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mds433"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdm543"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61763-2"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.12.019"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25149"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.2018.77.9892","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T04:06:04Z","timestamp":1653797164000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2018.77.9892"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,10]]},"references-count":28,"journal-issue":{"issue":"29","published-print":{"date-parts":[[2018,10,10]]}},"alternative-id":["10.1200\/JCO.2018.77.9892"],"URL":"https:\/\/doi.org\/10.1200\/jco.2018.77.9892","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.733585402.793578054","asserted-by":"object"}]},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,10]]},"assertion":[{"value":"2018-07-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}