Universität zu Köln

Baues, Christian, Goergen, Helen, Fuchs, Michael, Rosenbrock, Johannes, Celik, Eren, Eich, Hans, Kobe, Carsten, Voltin, Conrad-Amadeus, Engert, Andreas, Borchmann, Peter and Marnitz, Simone (2021). Involved-Field Radiation Therapy Prevents Recurrences in the Early Stages of Hodgkin Lymphoma in PET-Negative Patients After ABVD Chemotherapy: Relapse Analysis of GHSG Phase 3 HD16 Trial. Int. J. Radiat. Oncol. Biol. Phys., 111 (4). S. 900 - 907. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1879-355X

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Abstract

Purpose: The HD16 trial of the German Hodgkin Study Group (NCT00736320) demonstrated that radiation therapy in early stage Hodgkin lymphoma without risk factors cannot be safely omitted, and therefore combined modality therapy (CMT) remains the standard treatment. To demonstrate the local effect of consolidating involved-field radiation therapy (IF-RT), we performed an analysis of the recurrence pattern of positron emission tomography (PET)-negative HD16 patients. Methods and Materials: Between 2009 and 2015, 1150 patients with early-stage Hodgkin lymphoma without risk factors were randomly assigned to PET guided to 20 Gy IF-RT after 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy in the HD16 study of the German Hodgkin Study Group. The study was designed as a prospective randomized controlled trial. We correlated the localization of recurrence with the panel-based IF-RT plan, which was drawn up for all patients prospectively, blinded to treatment allocation. Accordingly, we were able to identify recurrences that occurred at least in part inside or outside of the (potential) radiation field (in-field and out-field, respectively). Results: There were 328 and 300 PET-negative patients assigned to CMT and PET-guided treatment (ie, chemotherapy alone), respectively. Within a median 47-month follow-up, disease progression or recurrence was documented for 15 and 29 patients treated with and without IF-RT, respectively. Relapse localization was unknown in 1 CMT patient. Without IF-RT, 5-year inci-dence of in-field relapses was 10.5% (95% confidence interval, 6.5-14.6) compared with 2.4% (0.5-4.3) with CMT (P = .0008). There were no relevant differences in out-field recurrences (5-year incidence 4.1% [1.7-6.6] vs 6.6% [3.0-10.3], P = .54). There was no grade 4 toxicity observed during IF-RT, and incidence of second primary malignancies was similar in both groups. Conclusions: PET-negative patients of the HD16 study showed no significant toxicity after 20 Gy IF-RT, and we demon-strated that omission of IF-RT resulted in more, particularly local, recurrences. Therefore, consolidation IF-RT should still be considered as standard therapy in this setting. (C) 2021 Elsevier Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Baues, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Goergen, Helen UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuchs, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenbrock, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Celik, Eren UNSPECIFIED UNSPECIFIED UNSPECIFIED Eich, Hans UNSPECIFIED UNSPECIFIED UNSPECIFIED Kobe, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Voltin, Conrad-Amadeus UNSPECIFIED UNSPECIFIED UNSPECIFIED Engert, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Borchmann, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Marnitz, Simone UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-569866
DOI:	10.1016/j.ijrobp.2021.07.1697
Journal or Publication Title:	Int. J. Radiat. Oncol. Biol. Phys.
Volume:	111
Number:	4
Page Range:	S. 900 - 907
Date:	2021
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1879-355X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTENSITY-MODULATED RADIOTHERAPY; BREAST-CANCER; RISK; DISEASE Multiple languages Oncology; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/56986