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Predictive Factor Analysis of Response-Adapted Radiation Therapy for Chemotherapy-Sensitive Pediatric Hodgkin Lymphoma: Analysis of the Children's Oncology Group AHOD 0031 Trial. Int J Radiat Oncol Biol Phys 2016 12 01;96(5):943-950

Date

11/22/2016

Pubmed ID

27869096

Pubmed Central ID

PMC5584603

DOI

10.1016/j.ijrobp.2016.07.015

Scopus ID

2-s2.0-85004074793   6 Citations

Abstract

PURPOSE: To evaluate whether clinical risk factors could further distinguish children with intermediate-risk Hodgkin lymphoma (HL) with rapid early and complete anatomic response (RER/CR) who benefit significantly from involved-field RT (IFRT) from those who do not, and thereby aid refinement of treatment selection.

METHODS AND MATERIALS: Children with intermediate-risk HL treated on the Children's Oncology Group AHOD 0031 trial who achieved RER/CR with 4 cycles of chemotherapy, and who were randomized to 21-Gy IFRT or no additional therapy (n=716) were the subject of this study. Recursive partitioning analysis was used to identify factors associated with clinically and statistically significant improvement in event-free survival (EFS) after randomization to IFRT. Bootstrap sampling was used to evaluate the robustness of the findings.

RESULT: Although most RER/CR patients did not benefit significantly from IFRT, those with a combination of anemia and bulky limited-stage disease (n=190) had significantly better 4-year EFS with the addition of IFRT (89.3% vs 77.9% without IFRT; P=.019); this benefit was consistently reproduced in bootstrap analyses and after adjusting for other prognostic factors.

CONCLUSION: Although most patients achieving RER/CR had favorable outcomes with 4 cycles of chemotherapy alone, those children with initial bulky stage I/II disease and anemia had significantly better EFS with the addition of IFRT as part of combined-modality therapy. Further work evaluating the interaction of clinical and biologic factors and imaging response is needed to further optimize and refine treatment selection.

Author List

Charpentier AM, Friedman DL, Wolden S, Schwartz C, Gill B, Sykes J, Albert-Green A, Kelly KM, Constine LS, Hodgson DC

Author

Cindy L. Schwartz MD, MPH Chief, Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Anemia
Antineoplastic Combined Chemotherapy Protocols
Bleomycin
Child
Child, Preschool
Cyclophosphamide
Disease-Free Survival
Doxorubicin
Etoposide
Factor Analysis, Statistical
Female
Hodgkin Disease
Humans
Male
Multivariate Analysis
Positron-Emission Tomography
Prednisone
Radiotherapy Dosage
Risk Factors
Time Factors
Treatment Outcome
Tumor Burden
Vincristine
Young Adult
jenkins-FCD Prod-461 7d7c6113fc1a2757d2947d29fae5861c878125ab