Predictive Factor Analysis of Response-Adapted Radiation Therapy for Chemotherapy-Sensitive Pediatric Hodgkin Lymphoma: Analysis of the Children's Oncology Group AHOD 0031 Trial

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• 作者：Anne-Marie Charpentier ; MD ; FRCP(C)^&dagger ; ; Debra L. Friedman ; MD ; MS^&Dagger ; ; Suzanne Wolden ; MD^§ ; ; Cindy Schwartz ; MD ; MPH^‖ ; Bethany Gill ; MMath^¶ ; ; Jenna Sykes ; MMath^¶ ; ; Alisha Albert-Green ; MSc^¶ ; ; Kara M. Kelly ; MD^# ; ^&lowast ; &lowast ; ; Louis S. Constine ; MD ; FASTRO^&dagger ; &dagger ; ; David C. Hodgson ; MD ; MPH^&lowast ; ; ^{David.hodgson@rmp.uhn.on.ca}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2016
• 出版时间：1 December 2016
• 年：2016
• 卷：96
• 期：5
• 页码：943-950
• 全文大小：432 K
• 卷排序：96

文摘

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 MaterialsChildren 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.ResultAlthough 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.ConclusionAlthough 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.