Andrea Gallamini1, Andrea Rossi2, Caterina Patti3, Marco Picardi4, Alessandra Romano5, Maria Cantonetti6, Sara Oppi7, Simonetta Viviani8, Silvia Bolis9, Livio Trentin10, Guido Gini11, Roberta Battistini12, Stephane Chauvie13, Roberto Sorasio14, Chiara Pavoni2, Roberta Zanotti15, Michele Cimminiello16, Corrado Schiavotto17, Piera Viero18, Antonino Mulé3, Federico Fallanca19, Umberto Ficola20, Corrado Tarella21,22, Luca Guerra23, Alessandro Rambaldi2,24. 1. Research and Clinical Innovation Department, A. Lacassagne Cancer Center, Nice, France. 2. Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy. 3. Hematology, V. Cervello Hospital, Palermo, Italy. 4. Hematology, Policlinico Federico II Hospital, Naples, Italy. 5. Hematology, Policlinico Vittorio Emanuele Hospital, Catania, Italy. 6. Hematology, Policlinico Universitario Tor Vergata, Rome, Italy. 7. Department of Hematology, Businco Hospital, Cagliari, Italy. 8. Department of Hematology, IRCCS National Institute of Tumors, Milan, Italy. 9. Hematology, San Gerardo Hospital, Monza, Italy. 10. Hematology, Medicine, Padua University, Padua, Italy. 11. Hematology, Ospedali Riuniti Le Torrette, Ancona, Italy. 12. Hematology, San Camillo Forlanini Hospital, Rome, Italy. 13. Medical Physics Unit, Santa Croce e Carle Hospital, Cuneo, Italy. 14. Hematology, Santa Croce e Carle Hospital, Cuneo, Italy. 15. Hematology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy. 16. Hematology, San Carlo Hospital, Potenza, Italy. 17. Hematology, San Bortolo Hospital, Vicenza, Italy. 18. Hematology Ospedale dell'Angelo, Mestre, Venice, Italy. 19. Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. 20. Nuclear Medicine Department, La Maddalena Hospital, Palermo, Italy. 21. Onco-Hematology European Institute of Oncology, IRCCS, Milan, Italy. 22. Department of Health Sciences, University of Milan, Milan, Italy. 23. Nuclear Medicine, San Gerardo University Hospital, Monza, Italy. 24. Department of Oncology-Hematology, University of Milan, Milan, Italy.
Abstract
PURPOSE: To investigate the role of consolidation radiotherapy (cRT) in advanced-stage Hodgkin lymphoma (HL) presenting at baseline with a large nodal mass (LNM) in complete metabolic response after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. PATIENTS AND METHODS: Advanced-stage (IIB-IVB) HL patients, enrolled in the HD 0607 trial (Clinicaltrial.gov identifier NCT00795613), with both a negative PET after two (PET-2) and six (PET-6) ABVD cycles, who presented at baseline with an LNM, defined as a nodal mass with the largest diameter ≥ 5 cm, were prospectively randomly assigned to receive cRT over the LNM or no further treatment (NFT). RESULTS: Among 296 randomly assigned patients, the largest diameter of LNM at baseline was 5-7 cm in 101 (34%; subgroup A) and 8-10 cm in 96 (32%; subgroup B), whereas classic bulky (diameter > 10 cm) was detected in 99 (33%; subgroup C). Two hundred eighty patients (88%) showed a postchemotherapy RM. The median dose of cRT was 30.6 Gy (range, 24-36 Gy). After a median follow-up of 5.9 years (range, 0.5-10 years), the 6-year progression-free survival rate of patients who underwent cRT or NFT was, respectively, 91% (95% CI, 84% to 99%) and 95% (95% CI, 89% to 100%; P = .62) in subgroup A; 98% (95% CI, 93% to 100%) and 90% (95% CI, 80% to 100%; P = .24) in subgroup B; 89% (95% CI, 81% to 98%) and 86% (95% CI, 77% to 96%; P = .53) in subgroup C (classic bulky). CONCLUSION:cRT could be safely omitted in patients with HL presenting with an LNM and a negative PET-2 and PET-6 scan, irrespective from the LNM size detected at baseline.
RCT Entities:
PURPOSE: To investigate the role of consolidation radiotherapy (cRT) in advanced-stage Hodgkin lymphoma (HL) presenting at baseline with a large nodal mass (LNM) in complete metabolic response after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. PATIENTS AND METHODS: Advanced-stage (IIB-IVB) HL patients, enrolled in the HD 0607 trial (Clinicaltrial.gov identifier NCT00795613), with both a negative PET after two (PET-2) and six (PET-6) ABVD cycles, who presented at baseline with an LNM, defined as a nodal mass with the largest diameter ≥ 5 cm, were prospectively randomly assigned to receive cRT over the LNM or no further treatment (NFT). RESULTS: Among 296 randomly assigned patients, the largest diameter of LNM at baseline was 5-7 cm in 101 (34%; subgroup A) and 8-10 cm in 96 (32%; subgroup B), whereas classic bulky (diameter > 10 cm) was detected in 99 (33%; subgroup C). Two hundred eighty patients (88%) showed a postchemotherapy RM. The median dose of cRT was 30.6 Gy (range, 24-36 Gy). After a median follow-up of 5.9 years (range, 0.5-10 years), the 6-year progression-free survival rate of patients who underwent cRT or NFT was, respectively, 91% (95% CI, 84% to 99%) and 95% (95% CI, 89% to 100%; P = .62) in subgroup A; 98% (95% CI, 93% to 100%) and 90% (95% CI, 80% to 100%; P = .24) in subgroup B; 89% (95% CI, 81% to 98%) and 86% (95% CI, 77% to 96%; P = .53) in subgroup C (classic bulky). CONCLUSION: cRT could be safely omitted in patients with HL presenting with an LNM and a negative PET-2 and PET-6 scan, irrespective from the LNM size detected at baseline.
Authors: Monika L Metzger; Michael P Link; Amy L Billett; Jamie Flerlage; John T Lucas; Belinda N Mandrell; Matthew J Ehrhardt; Nickhill Bhakta; Torunn I Yock; Alison M Friedmann; Pedro de Alarcon; Sandra Luna-Fineman; Eric Larsen; Sue C Kaste; Barry Shulkin; Zhaohua Lu; Chen Li; Susan M Hiniker; Sarah S Donaldson; Melissa M Hudson; Matthew J Krasin Journal: J Clin Oncol Date: 2021-04-07 Impact factor: 50.717