Outcomes of patients with stage I–II Hodgkin lymphoma who had uniform pre-treatment staging with PET/CT and treatment with limited field radiation therapy after chemotherapy

Ninety-six patients were eligible. Consent for medical record-based research was declined by 3. The remaining 93 patients form the basis of this study.

Patient characteristics are summarized in the Table. Unfavorable disease was present in 52 patients (56%) [9]. The Median follow-up was 7.5 years.

ABVD was used in 86 patients (92%) (Table 1). Thirty patients (32%) received 1–3 cycles of chemotherapy and the remainder received 4–6 cycles. The dose of radiation was 20–21 Gy in 55 patients (59%), >21 to ≤30 Gy in 32 (34%) and >30 Gy in 6 (6%). Three dimensional conformal RT was used in 66 patients (71%) and intensity modulated RT was used in 27 (29%). ISRT was used in 84 patients (90%), and IFRT in 9 (10%).

Table 1 Patient characteristics.

Eighty-nine patients were evaluated for response following chemotherapy by PET/CT: 84 (94%) had a CR and 5 (6%) had a PR. All 4 patients evaluated by CT following chemotherapy had a CR.

Survival and cumulative incidence of recurrence are shown in the Figure.

Overall survival at 5 and 10 was 98.9% (95% CI 96.5–100%) and 96.6% (95% CI 90.3–100%).Three patients died, all of causes that did not appear to be related to prior RT (Fig. 1). Heart failure was the cause of death in a 74-year-old who had a history of this problem before RT. Cor pulmonale was the cause of death in a 71 year old whose RT fields were limited to the right neck. An 88-year-old patient treated with RT to the left axilla and supraclavicular area died of aortic stenosis and dementia.

Fig. 1: Survival and cumulative incidence of recurrence.figure 1

Overall survival (red) and cumulative incidence of recurrence (blue).

The cumulative incidence of recurrence at 5 and 10 years was 1.2% (95% CI 0.2–8.5%). Two relapses occurred, both with disease in prior RT fields.

The most common acute toxicity was esophagitis, documented in 45 patients (48%), with 44 and 1 patients experiencing grade 2 and 3 symptoms, respectively. Eleven patients (12%) experienced grade 1 (10 patients) or grade 2 (1 patient) acute skin toxicity. One patient experienced acute grade 2 oral mucositis and one experienced grade 3 oral mucositis.

The most common post-RT toxicity was hypothyroidism. No post-RT thyroid toxicity was observed in the 13 patients who did not have thyroid gland in the radiation fields. In the remaining 80 patients hypothyroidism was documented in 28 (35%) with 8 and 20 patients experiencing grade 1 and 2 toxicity, respectively. There was one case each of multi-nodular goiter, benign thyroid nodule and Hashimoto’s thyroiditis.

All other acute and post-RT toxicities occurred with a frequency of less than 3%, and in no case did any other toxicity exceed grade 2.

Six patients were diagnosed with post-treatment second malignancies, excluding non-melanoma skin cancers: Ewing sarcoma at 1.7 years, follicular lymphoma at 3.2 years, prostate cancer at 5.4 years, melanoma at 5.8 years, chronic lymphocytic leukemia at 11.1 years, and multiple myeloma at 13.8 years.

留言 (0)

沒有登入
gif