Potential Benefit of Involved-Field Radiotherapy for Patients With Relapsed-Refractory Hodgkin's Lymphoma With Incomplete Response Before Autologous Stem Cell Transplantation |
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| Institution: | 1. Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy;2. Department of Hematology, A.O.U. Città della Salute e della Scienza, Torino, Italy;3. Department of Hematology, Ospedale Civile, Ciriè, Torino, Italy;4. Department of Internal Medicine and Hematology, San Luigi Hospital, Orbassano, Torino, Italy;5. Department of Hematology, Mauriziano Hospital, Torino, Italy;1. Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA;2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA;3. Gelb Center for Translational Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA;4. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA;5. Department of Radiation Oncology, Brigham and Women''s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA;1. Institut Jean-Godinot, département d’oncologie, 1, rue du Général-Koenig, 51726 Reims cedex, France;2. Hôpital Saint-Antoine, service d’oncologie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France;3. Institut Paoli-Calmettes, département d’oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France;4. CHU de Clermont-Ferrand, service de thérapie cellulaire et d’hématologie clinique adulte, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France;5. Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France;6. Institut Curie, département de pédiatrie, adolescents et jeunes adultes, rue d’Ulm, 75005 Paris, France;7. Centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France;8. Centre Antoine-Lacassagne, département de radiothérapie, 33, avenue Valombrose, 06189 Nice, France;9. Hôpital Tenon, service de pneumologie, 4, rue de la Chine, 75020 Paris, France;1. Service de radiothérapie, pôle régional de cancérologie, CHU de Poitiers, 350, avenue Jacques-C?ur, 86000 Poitiers, France;2. Service de radiothérapie, groupe Oncorad Garonne, clinique Pasteur, « L’Atrium », 1, rue de la Petite-Vitesse, 31300 Toulouse, France;3. Service de radiothérapie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France;4. Service de radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris cedex, France;5. Service de radiothérapie, institut de cancérologie de l’Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France;6. UF radiophysique, pôle régional de cancérologie, CHU de Poitiers, 350, avenue Jacques-C?ur, 86000 Poitiers, France;7. Service d’urologie, CHU Rangueil, 1, avenue du Pr-Jean-Poulhès, 31400 Toulouse, France;8. Service de radiothérapie, centre régional de lutte contre le cancer, institut Bergonié, 229, cours de l’Argonne, 33076 Bordeaux, France;9. Service d’urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France;1. Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia;2. University of New South Wales, Sydney, Australia;3. Ingham Institute of Applied Medical Research, Liverpool, Australia;4. Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, Australia;5. University of Western Sydney, Sydney, Australia;7. University of Newcastle, Callaghan, Australia |
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| Abstract: | IntroductionWe investigated for a possible role for peritransplantation involved-field radiotherapy (IFRT) by comparing patients who received IFRT before after autologous stem cell transplantation (ASCT) and patients who received salvage chemotherapy (CT) alone.Patients and MethodsWe retrospectively evaluated 73 consecutive patients with Hodgkin lymphoma treated with ASCT between 2003 and 2014. Twenty-one patients (28.8%) received peritransplantation radiotherapy. A Cox regression analysis (multivariate analysis; MVA) was performed to evaluate the prognostic role of any risk factor. Overall survival (OS) and progression-free survival (PFS) were calculated from the date of ASCT. Response to CT and ASCT were evaluated with positron emission tomography (PET) scan.ResultsMedian follow-up was 41 months (range, 1-136 months). Overall, no significant difference appeared between patients who received IFRT and patients treated with CT alone; however, patients who were treated with IFRT had worse prognostic factors. In the MVA, advanced stage at relapse and persistent disease before ASCT (evident on PET scan PET+]) were related to worse PFS and OS. In patients with limited stage disease at relapse and PET+, peritransplantation radiotherapy showed higher 3-year OS rates (91.7% vs. 62.3%) and PFS rates (67.5% vs. 50%) compared with patients treated with CT alone, although this difference was not significant (P = .14 and P = .22, respectively).ConclusionIFRT used before or after ASCT might partially compensate for worse prognostic factors among the overall population; subgroup analysis showed a trend for survival benefit at 3 years in patients with limited stage disease at relapse and PET+ before ASCT. |
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| Keywords: | Autologous stem cell transplant Hodgkin's lymphoma Involved field radiotherapy Peritransplant radiotherapy Prognostic factors |
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