Jan Kriz1, Gabriele Reinartz1, Markus Dietlein2, Carsten Kobe2, Georg Kuhnert2, Heinz Haverkamp3, Uwe Haverkamp1, Rita Engenhart-Cabillic4, Klaus Herfarth5, Peter Lukas6, Heinz Schmidberger7, Susanne Staar8, Kira Hegerfeld1, Christian Baues9, Andreas Engert3, Hans Theodor Eich10. 1. Department of Radiation Oncology, University of Münster, Münster, Germany. 2. Department of Nuclear Medicine, University of Cologne, Cologne, Germany. 3. First Department of Internal Medicine, University of Cologne, Cologne, Germany. 4. Department of Radiation Oncology, University of Marburg, Marburg, Germany. 5. Department of Radiation Oncology, University Heidelberg, Heidelberg, Germany. 6. Department of Radiation Oncology, University of Innsbruck, Innsbruck, Austria. 7. Department of Radiation Oncology, University of Mainz, Mainz, Germany. 8. Department of Radiation Oncology, Klinikum Bremen-Mitte, Bremen, Germany. 9. Department of Radiation Oncology, University of Cologne, Cologne, Germany. 10. Department of Radiation Oncology, University of Münster, Münster, Germany. Electronic address: hans.eich@ukmuenster.de.
Abstract
PURPOSE: To determine, in the setting of advanced-stage of Hodgkin lymphoma (HL), whether relapses occur in the irradiated planning target volume and whether the definition of local radiation therapy (RT) used by the German Hodgkin Study Group (GHSG) is adequate, because there is no harmonization of field and volume definitions among the large cooperative groups in the treatment of advanced-stage HL. METHODS AND MATERIALS: All patients with residual disease of ≥ 2.5 cm after multiagent chemotherapy (CTX) were evaluated using additional positron emission tomography (PET), and those with a PET-positive result were irradiated with 30 Gy to the site of residual disease. We re-evaluated all sites of disease before and after CTX, as well as the PET-positive residual tumor that was treated in all relapsed patients. Documentation of radiation therapy (RT), treatment planning procedures, and portal images were carefully analyzed and compared with the centrally recommended RT prescription. The irradiated sites were compared with sites of relapse using follow-up computed tomography scans. RESULTS: A total of 2126 patients were enrolled, and 225 patients (11%) receivedRT. Radiation therapy documents of 152 irradiated patients (68%) were analyzed, with 28 irradiated patients (11%) relapsing subsequently. Eleven patients (39%) had an in-field relapse, 7 patients (25%) relapsed outside the irradiated volume, and an additional 10 patients (36%) showed mixed in- and out-field relapses. Of 123 patients, 20 (16%) with adequately performed RT relapsed, compared with 7 of 29 patients (24%) with inadequate RT. CONCLUSIONS: The frequency and pattern of relapses suggest that local RT to PET-positive residual disease is sufficient for patients in advanced-stage HL. Insufficient safety margins of local RT may contribute to in-field relapses.
RCT Entities:
PURPOSE: To determine, in the setting of advanced-stage of Hodgkin lymphoma (HL), whether relapses occur in the irradiated planning target volume and whether the definition of local radiation therapy (RT) used by the German Hodgkin Study Group (GHSG) is adequate, because there is no harmonization of field and volume definitions among the large cooperative groups in the treatment of advanced-stage HL. METHODS AND MATERIALS: All patients with residual disease of ≥ 2.5 cm after multiagent chemotherapy (CTX) were evaluated using additional positron emission tomography (PET), and those with a PET-positive result were irradiated with 30 Gy to the site of residual disease. We re-evaluated all sites of disease before and after CTX, as well as the PET-positive residual tumor that was treated in all relapsed patients. Documentation of radiation therapy (RT), treatment planning procedures, and portal images were carefully analyzed and compared with the centrally recommended RT prescription. The irradiated sites were compared with sites of relapse using follow-up computed tomography scans. RESULTS: A total of 2126 patients were enrolled, and 225 patients (11%) received RT. Radiation therapy documents of 152 irradiated patients (68%) were analyzed, with 28 irradiated patients (11%) relapsing subsequently. Eleven patients (39%) had an in-field relapse, 7 patients (25%) relapsed outside the irradiated volume, and an additional 10 patients (36%) showed mixed in- and out-field relapses. Of 123 patients, 20 (16%) with adequately performed RT relapsed, compared with 7 of 29 patients (24%) with inadequate RT. CONCLUSIONS: The frequency and pattern of relapses suggest that local RT to PET-positive residual disease is sufficient for patients in advanced-stage HL. Insufficient safety margins of local RT may contribute to in-field relapses.
Authors: Vitaliana DE Sanctis; Alice DI Rocco; Maria Christina Cox; Maurizio Valeriani; Francesca Perrone Congedi; Dimitri Anzellini; Maria Massaro; Gianluca Vullo; Giuseppe Facondo; Flavia DE Giacomo; Marco Alfò; Daniela Prosperi; Patrizia Pizzichini; Sabrina Pelliccia; Agostino Tafuri; Maurizio Martelli; Mattia Falchetto Osti Journal: In Vivo Date: 2020 May-Jun Impact factor: 2.155
Authors: J Kriz; C Baues; R Engenhart-Cabillic; U Haverkamp; K Herfarth; P Lukas; H Schmidberger; S Marnitz-Schulze; M Fuchs; A Engert; H T Eich Journal: Strahlenther Onkol Date: 2016-09-27 Impact factor: 3.621
Authors: Chul S Ha; Michael LeBlanc; Heiko Schöder; Chelsea C Pinnix; Nancy L Bartlett; Andrew M Evens; Eric D Hsi; Lisa Rimsza; Michael V Knopp; Jun Zhang; John P Leonard; Brad S Kahl; Hongli Li; Sonali Smith; Louis S Constine; Jonathan W Friedberg Journal: Leuk Lymphoma Date: 2020-05-26
Authors: J Kriz; C Baues; R Engenhart-Cabillic; U Haverkamp; K Herfart; P Lukas; A Plütschow; H Schmidberger; S Staar; M Fuchs; A Engert; H T Eich Journal: Strahlenther Onkol Date: 2016-09-05 Impact factor: 3.621
Authors: Bradford S Hoppe; Raymond B Mailhot Vega; Nancy P Mendenhall; Eric S Sandler; William B Slayton; Howard Katzenstein; Michael J Joyce; Zuofeng Li; Stella Flampouri Journal: Int J Part Ther Date: 2020-04-27