1
|
Cooper BT, Mayo CS, Milano MT, Olch AJ, Oh C, Keating GF, Hallstrom A, Constine LS, Laack NN. Predictive Factors Associated With Radiation Myelopathy in Pediatric Patients With Cancer: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:494-506. [PMID: 38323945 DOI: 10.1016/j.ijrobp.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Radiation myelitis (RM) is a rare complication of radiation therapy (RT). The Pediatric Normal Tissue Effects in the Clinic spinal cord task force aimed to identify RT dose effects and assess risk factors for RM in children. Through systematic review, we analyzed RT dose, fraction size, latency between completion of RT and toxicity, chemotherapy use, age when irradiated, and sex. METHODS AND MATERIALS We conducted literature searches of peer-reviewed manuscripts published from 1964 to June 2017 evaluating RM among children. Normality of variables was assessed with Kolmogorov-Smirnov or Shapiro-Wilk tests. Spearman's rank correlation coefficients were used to test correlations between RT dose/fraction size and latency between RT and development of toxicity. RESULTS Of 1329 identified and screened reports, 144 reports were fully reviewed and determined to have adequate data for analysis; 16 of these reports had a total of 33 cases of RM with a median age of 13 years (range, 0.2-18) at the time of RT. The most common primary tumor histologies were rhabdomyosarcoma (n = 9), medulloblastoma (n = 5), and Hodgkin lymphoma (n = 2); the most common chemotherapy agents given were vincristine (n = 15), intrathecal methotrexate (n = 12), and intrathecal cytarabine (n = 10). The median RT dose and fraction size were 40 Gy (range, 24-57.4 Gy) and 1.8 Gy (range, 1.3-2.6 Gy), respectively. RT dose resulting in RM in patients who also received chemotherapy was lower than in those not receiving chemotherapy (mean 39.6 vs 49.7 Gy; P = .04). There was no association of age with RT dose. The median latency period was 7 months (range, 1-29). Higher RT dose was correlated with longer latency periods (P = .03) to RM whereas sex, age, fraction size, and chemotherapy use were not. Two of 17 patients with adequate follow-up recovered from RM; unfortunately, it was fatal in 6 of 15 evaluable patients. Complication probability modeling was not possible because of the rarity of events. CONCLUSIONS This report demonstrates a relatively short latency from RT (with or without chemotherapy) to RM and a wide range of doses (including fraction sizes) associated with RM. No apparent association with age at the time of RT could be discerned. Chemotherapy appears to reduce spinal cord tolerance. Recovery from RM is rare, and it is often fatal.
Collapse
Affiliation(s)
- Benjamin T Cooper
- Department of Radiation Oncology, NYU Langone School of Medicine, New York, New York.
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Arthur J Olch
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Cheongeun Oh
- Department of Population Health, NYU School of Medicine, New York, New York
| | | | - Anneka Hallstrom
- Department of Physics, Wellesley College, Wellesley, Massachusetts
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
2
|
Lo AC, Ronckers C, Aznar MC, Avanzo M, van Dijk I, Kremer LCM, Gagliardi G, Howell RM, Rancati T, Constine LS, Marcus KJ. Breast Hypoplasia and Decreased Lactation From Radiation Therapy in Survivors of Pediatric Malignancy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:549-559. [PMID: 34627655 DOI: 10.1016/j.ijrobp.2021.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Breast hypoplasia and impaired lactation are poorly studied sequelae of chest radiation therapy (RT) in children. The Pediatric Normal Tissue Effects in the Clinic female breast task force aimed to quantitate the radiation dose-volume effects on these endpoints. METHODS AND MATERIALS A literature search was conducted of peer-reviewed manuscripts evaluating breast hypoplasia and lactation after chest RT in children, yielding 789 abstracts. Only 2 studies on children irradiated at <4 years of age for angioma of the breast provided dosimetric data correlated with breast hypoplasia. For patients who received brachytherapy, the dose was converted to external beam RT in equivalent 2 Gy fractions (DEBRT), although the limitations of this type of mathematical conversion need to be recognized. We calculated relative risks (RR) and 95% confidence intervals (95% CIs) based on these data. Only 1 study was relevant to the lactation endpoint, in which patients were given RT for Hodgkin lymphoma at age 14 to 40 years. RESULTS The 3 studies involved 206 patients in total. In patients <4 years old at the time of RT, the prevalence of patient-perceived breast hypoplasia was 38% (RR 2.5; 95% CI, 1.3-4.6) after DEBRT of <0.34 Gy, 61% (RR 4.0; 95% CI, 2.1-7.4) after DEBRT 0.34-0.97 Gy, and 97% (RR 6.3; 95% CI, 3.6-10.8) after DEBRT ≥0.97 Gy to the breast anlage. A simple linear regression model (r = 0.72; P < .001) showed that the treated breast was smaller than the untreated breast by 13% at DEBRT = 0.5 Gy, 20% at DEBRT = 1 Gy, 32% at DEBRT = 2 Gy, 51% at DEBRT = 4 Gy, 66% at DEBRT = 6 Gy, 79% at DEBRT = 8 Gy, and 90% at DEBRT = 10 Gy. The risk of unsuccessful breastfeeding was 39% after a median mediastinal dose of 41 Gy, compared with 21% in a sibling control group (P = .04). RT dose of ≥42 Gy was not associated with less breastfeeding success compared with <42 Gy, and data on lower doses were unavailable. CONCLUSIONS Based on extremely limited data, young adults exposed to thoracic RT as children seem to be at significant risk of breast hypoplasia and impaired lactation. Doses as low as 0.3 Gy to immature breasts can cause breast hypoplasia. Additional studies are needed to quantify dose and technique effects with modern RT indications. Prospective collection of clinical outcomes and dosimetric factors would enhance our understanding of RT-induced breast hypoplasia and impaired lactation.
Collapse
Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada.
| | - Cecile Ronckers
- Department of Pediatric Oncology, Prinses Maxima Centrum, Utrecht, the Netherlands
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Irma van Dijk
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Department of Pediatrics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Giovanna Gagliardi
- Department of Medical Physics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Karen J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
3
|
Saddi J, Barcellini A, Gotti M, Mazzacane A, Tolva A, Lazic T, Arcaini L, Zecca M, Orlandi E, Filippi AR. Future perspectives of radiation therapy for Hodgkin Lymphoma: Risk-adapted, response-adapted, and safer than before. Hematol Oncol 2024; 42:e3269. [PMID: 38650534 DOI: 10.1002/hon.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
Classical Hodgkin lymphoma is a lymphoproliferative disease with a good prognosis mainly seen in young people. Nevertheless secondary malignancy, cardiac disease and infertility may affect the long survivors with significant impact on quality of life, morbidity and overall survival. In the last decades several treatment strategies were evaluated to reduce the toxicity of first line treatment such as avoiding radiotherapy or its reduction in terms of dosage and extension. Many trials including interim Positron Emission Tomography evaluation fail to compare efficacy between combined modality treatment versus chemotherapy alone in particular in early stage disease. In this review we analyze which subset of patients could take advantage from proton therapy in terms of toxicity and cost effectiveness.
Collapse
Affiliation(s)
- Jessica Saddi
- Radiation Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Manuel Gotti
- Division of Hematology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Alessandra Tolva
- Pediatric Hematology/Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Tanja Lazic
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Luca Arcaini
- Division of Hematology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Oncology, University of Milan, Milan, Italy
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| |
Collapse
|
4
|
Boullaud L, Bergemer AM, Micaletti F, Periers L, Bakhos D. [Radiation-induced parotid leiomyosarcoma]. Ann Pathol 2024; 44:210-214. [PMID: 38448265 DOI: 10.1016/j.annpat.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/05/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION First case of radiation-induced parotid leiomyosarcoma. ANATOMO-CLINICAL OBSERVATION A 50-year-old woman with a history of cervical irradiation for Hodgkin's lymphoma presented with a right parotid tumefaction. Examination noted a deep adherent pretragal mass with peripheral facial palsy. A total parotidectomy with intra-operative examination and cervical curage was performed. Histopathological analysis concluded to a grade 3 parotid leiomyosarcoma according to the National Federation of Cancer Centers. Adjuvant radiotherapy was performed. After 24 months of follow-up, the patient presented bone and liver metastases without local recurrence. DISCUSSION This is the first case of radiation-induced leiomyosarcoma and the 12th case of parotid leiomyosarcoma described in the literature. The management associates surgery with adjuvant radiotherapy. Follow-up is by clinical examination, parotid MRI, and annual thoracoabdominal CT scan to search for metastases. Recurrences occur during the first year in 40 to 64% of cases, and distant metastases in 40 to 60% of cases. The 5-year survival rate is between 10 and 30%.
Collapse
Affiliation(s)
- Luc Boullaud
- Service ORL et chirurgie cervico-faciale, CHU de Tours, boulevard Tonnellé, 37044 Tours, France.
| | | | - Fabrice Micaletti
- Service ORL et chirurgie cervico-faciale, CHU de Tours, boulevard Tonnellé, 37044 Tours, France
| | - Lea Periers
- Service ORL et chirurgie cervico-faciale, CHU de Tours, boulevard Tonnellé, 37044 Tours, France
| | - David Bakhos
- Service d'anatomie et cytologie pathologiques, Inserm UMR 1253 I-brain, CHRU de Tours, université François-Rabelais de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine de Tours, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; House Institute Foundation, Los Angeles, CA 90057, États-Unis
| |
Collapse
|
5
|
Dover L, Dulaney C. PROshot: Regional Nodal Irradiation, Prophylactic Radiation for Bone Metastases, Adaptive Therapy for Hodgkin Lymphoma, Immunoscore, and Heart Dosimetry. Pract Radiat Oncol 2024; 14:175-180. [PMID: 38702114 DOI: 10.1016/j.prro.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Laura Dover
- Department of Radiation Oncology, Ascension St. Vincent's East, Birmingham, Alabama
| | - Caleb Dulaney
- Department of Radiation Oncology, Anderson Regional Health System, Meridian, Mississippi.
| |
Collapse
|
6
|
Kowalska M, Sitarz-Kilian E, Jaros K, Koperny M, Moćko P, Siwiec J, Kawalec P. Evidence for external beam radiotherapy in mediastinal Hodgkin and non-Hodgkin lymphoma - systematic review. Ann Agric Environ Med 2024; 31:47-56. [PMID: 38549476 DOI: 10.26444/aaem/168272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION AND OBJECTIVE Proton beam therapy (PBT) provides the opportunity for a more localized delivery of high energy protons and may reduce the damage to healthy tissues and vital organs. The aim of this review was to assess the effects of proton therapy for patients diagnosed with Hodgkin or non-Hodgkin lymphoma treated with mediastinal irradiation. REVIEW METHODS A systematic search of EMBASE, MEDLINE via OVID and Cochrane Library was conducted in May 2022 according to PRISMA guidelines to identify relevant data on the efficacy and toxicity of proton beam therapy for patients diagnosed with Hodgkin or non-Hodgkin lymphoma. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE Of 566 screened abstracts (430 after de-duplication) 11 studies with a total of 529 patients were included. All studies were case series published between 2011-2021. Median range of follow-up time was 15-63.6 months. The overall survival (OS) for 2 years varied from 91% - 98% for 5 of the included studies. Three of the included studies had favourable outcomes with 2-year progression-free survival (PFS) ranging from 73% - 94%. Skin reaction, oesophagitis and fatigue were found to be the most common grade 1 and grade 2 toxicities. No acute or late grade 4 and higher toxicities/adverse events were observed. SUMMARY There are data indicating that PBT may to be an effective treatment against mediastinal Hodgkin and non-Hodgkin lymphoma. Because all the studies were case series, the authors of this review have little confidence in the evidence. There remains a need for well-designed randomized controlled trials to inform about the optimal approach to proton irradiation in HL and NHL.
Collapse
Affiliation(s)
- Malwina Kowalska
- Healthcare Services Department, Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
| | - Ewelina Sitarz-Kilian
- Healthcare Services Department, Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
| | - Klaudia Jaros
- Healthcare Services Department, Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
| | - Magdalena Koperny
- Healthcare Services Department, Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Moćko
- Healthcare Services Department, Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
- Health Policy and Management Department; Institute of Public Health; Faculty of Health Sciences; Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Siwiec
- Healthcare Services Department, Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
| | - Paweł Kawalec
- Department of Nutrition and Drug Research, Institute of Public Health; Faculty of Health Sciences; Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
7
|
Doğan M, Demirsoy U, Başar EZ, Babaoğlu K. Mediastinal Radiotherapy-induced Early-onset Valvulopathy in a 6-Year-old Boy With Hodgkin Lymphoma. J Pediatr Hematol Oncol 2024; 46:e205-e207. [PMID: 38113229 DOI: 10.1097/mph.0000000000002801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
Mediastinal radiotherapy for childhood cancers, particularly Hodgkin disease, has numerous potential adverse effects, including coronary artery disease, pericarditis, cardiomyopathy, valvular disease, and conduction abnormalities. The prevalence of valvular stenosis is relatively low, and regurgitation is more common. Mediastinal radiotherapy-induced valvular disease develops more than 10 years after radiotherapy. Here, we present a case of a 6-year-old boy with moderate to significant mitral stenosis + moderate mitral regurgitation and mild aortic regurgitation that appeared 1.5 months after radiotherapy and showed a progressive course.
Collapse
Affiliation(s)
- Mustafa Doğan
- Pediatric Oncology, Kocaeli University, Kocaeli, Turkey
| | - Uğur Demirsoy
- Pediatric Oncology, Kocaeli University, Kocaeli, Turkey
| | | | | |
Collapse
|
8
|
Ollivier L, Debbi K, To NH, Cailleteau A, Supiot S, Mervoyer A, Guimas V, Belkacémi Y. Is oligometastatic disease an applicable and useful concept in haematologic malignancies? A narrative review of radiation therapy standards, modern techniques, and innovations. Cancer Radiother 2024; 28:119-130. [PMID: 38143233 DOI: 10.1016/j.canrad.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Haematologic malignancies are particular in that they can generally be cured, even when distant metastases are present at diagnosis, unlike solid malignancies. Systemic treatments, including chemotherapy, targeted therapies, and immunotherapy, are the standard of care with excellent results. The considerable progress made in the management of these diseases in the last 20years has redefined the role of radiation therapy as minor in many clinical situations. We propose a literature review of data, showing that radiation therapy still has a role in curative, salvage, and palliative therapy situations. MATERIAL AND METHODS A document and literature search was carried out in the following databases: Medline and ClinicalTrial.gov, for the terms "radiotherapy", "haematologic malignancies", "Hodgkin lymphoma", "non-Hodgkin lymphoma", "CAR T cells", "multiple myeloma", "solitary plasmocytoma", "intensity-modulated radiotherapy", "extracranial stereotactic body radiation therapy" and "proton therapy references". RESULTS Haemopathological malignancies include a wide range of diseases and radiation therapy indications have been assessed over the past 20years. Currently, radiation therapy is indicated for localized disease (solitary plasmocytoma), as an adjuvant (Hodgkin lymphoma), in palliative settings, or after systemic treatment in relapsed patients (chimeric antigen receptor [CAR] T-cells) with a low recurrence burden, which can therefore be considered "oligorecurrence". Radiation therapy, through total body irradiation, has important indications, thanks to its immunomodulatory and/or myeloablative effects. Moreover, recent technological developments have made possible significant improvement in safety, contributing to radiation therapy being positioned in the treatment strategy of several indications. CONCLUSIONS Given the effectiveness of systemic treatments in hematologic malignancies, the oligometastasis stage is of little importance. A curative intent after local radiation therapy, even advanced stage, is possible, both with residual disease for advanced Hodgkin lymphoma, aggressive non-Hodgkin lymphoma, or solitary plasmocytoma, and even without evidence of disease after chemotherapy for Hodgkin or non-Hodgkin lymphoma. The role of new treatments, such as CAR T cells, allows us to consider radiation therapy after systemic treatment of relapsed diseases with low volume recurrence, which can be considered oligorecurrence.
Collapse
Affiliation(s)
- L Ollivier
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France.
| | - K Debbi
- Department of Radiation Oncology, centre Sein Henri-Mondor, CHU Henri-Mondor, AP-HP, university Paris Est Créteil (Upec), Créteil, France
| | - N-H To
- Department of Radiation Oncology, centre Sein Henri-Mondor, CHU Henri-Mondor, AP-HP, university Paris Est Créteil (Upec), Créteil, France; Institut Mondor de recherche biomédicale (IMRB), Inserm U955, i-Biot, Créteil, France
| | - A Cailleteau
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - S Supiot
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - A Mervoyer
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - V Guimas
- Service d'oncologie radiothérapie, Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - Y Belkacémi
- Department of Radiation Oncology, centre Sein Henri-Mondor, CHU Henri-Mondor, AP-HP, university Paris Est Créteil (Upec), Créteil, France; Institut Mondor de recherche biomédicale (IMRB), Inserm U955, i-Biot, Créteil, France
| |
Collapse
|
9
|
Yilmaz MT, Kamer S, Agaoglu F, Hayran KM, Yildiz F. Involved-site Radiotherapy Delineation Dilemmas in the Treatment of Adult Hodgkin Lymphoma: Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology and TBI Study Group Case-based Questionnaire Review (TROD 03-005). Clin Oncol (R Coll Radiol) 2024; 36:80-86. [PMID: 38042670 DOI: 10.1016/j.clon.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
AIMS The International Lymphoma Radiation Oncology Group (ILROG) defined involved-site radiotherapy (ISRT) guidelines. These rules offer a certain variability that allows for autonomous decision-making in diverse clinical settings. However, this flexibility also gives rise to conflicts about the selection of treatment fields in the daily decision-making process. The aim of this study was to show the extent of interobserver variability when ILROG-ISRT recommendations were used in different clinical scenarios. MATERIALS AND METHODS The 10-question survey used in our study consisted of two parts (part A and part B) and was prepared by four senior radiation oncologists experienced in the haemato-oncology field. The results were presented by stratifying according to clinical experience (<10 years, ≥10 years). Binomial tests (one-sided) were conducted to assess whether answers for each group and the whole group reached a consensus. RESULTS Twenty-six radiation oncologists, 13 of whom had less than 10 years of experience and 13 seniors, participated in the survey. Eighty per cent of respondents thought ILROG did not bring sufficient solutions for all clinical scenarios but offered solutions in some cases. In different case-based scenarios, the consensus among the respondents decreased down to 38%. Senior radiation oncologists were found to have more doubts about the adequacy of current guidelines. CONCLUSIONS ILROG guidelines allow for a high degree of variability in real-life clinical scenarios and different interpretation of the recommendations may lead to increased toxicity and recurrences. Therefore, there is a need for refinement in ISRT delineation strategies. On behalf of the Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology and TBI Study Group, we are planning to carry out further educational contouring sessions to detect the interobserver variability in real-life contouring cases.
Collapse
Affiliation(s)
- M T Yilmaz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Kamer
- Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - F Agaoglu
- Department of Radiation Oncology, Acibadem Mehmet Aydinlar University Faculty of Medicine, Istanbul, Turkey
| | - K M Hayran
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| |
Collapse
|
10
|
Lo AC, Liu A, Liu Q, Yasui Y, Castellino SM, Kelly KM, Hererra AF, Friedberg JW, Friedman DL, Schwartz CL, Pei Q, Kessel S, Bergeron-Gravel S, Dama H, Roberts K, Constine LS, Hodgson DC. Late Cardiac Toxic Effects Associated With Treatment Protocols for Hodgkin Lymphoma in Children. JAMA Netw Open 2024; 7:e2351062. [PMID: 38241048 PMCID: PMC10799264 DOI: 10.1001/jamanetworkopen.2023.51062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/20/2023] [Indexed: 01/22/2024] Open
Abstract
Importance Contemporary North American trials for children with Hodgkin lymphoma (HL) have decreased radiation therapy (RT) use and increased pharmacologic cardioprotection but also increased the cumulative doxorubicin dose, making overall treatment consequences for late cardiac toxic effects uncertain. Objective To estimate the risk of cardiac toxic effects associated with treatments used in modern pediatric HL clinical trials. Design, Setting, and Participants For this cohort study, Fine and Gray models were fitted using survivors in the Childhood Cancer Survivor Study who were diagnosed with HL between January 1, 1970, and December 31, 1999, and were followed for a median of 23.5 (range, 5.0-46.3) years. These models were applied to the exposures in the study population to estimate the 30-year cumulative incidence of cardiac disease. The study population comprised patients with intermediate-risk or high-risk HL treated in 4 consecutive Children's Oncology Group clinical trials from September 2002 to October 2022: AHOD0031, AHOD0831, AHOD1331, and S1826. Data analysis was performed from April 2020 to February 2023. Exposures All patients received chemotherapy including doxorubicin, and some patients received mediastinal RT, dexrazoxane, or mediastinal RT and dexrazoxane. Main Outcomes and Measures Estimated 30-year cumulative incidence of grade 3 to 5 cardiac disease. Results The study cohort comprised 2563 patients, with a median age at diagnosis of 15 (range, 1-22) years. More than half of the patients were male (1357 [52.9%]). All 2563 patients received doxorubicin, 1362 patients (53.1%) received mediastinal RT, and 307 patients (12.0%) received dexrazoxane. Radiation therapy use and the median mean heart dose among patients receiving RT decreased, whereas the planned cumulative dose of doxorubicin and use of dexrazoxane cardioprotection increased. For patients treated at age 15 years, the estimated 30-year cumulative incidence of severe or fatal cardiac disease was 9.6% (95% CI, 4.2%-16.4%) in the AHOD0031 standard treatment group (enrolled 2002-2009), 8.6% (95% CI, 3.8%-14.9%) in the AHOD0831 trial (enrolled 2009-2012), 8.2% (95% CI, 3.6%-14.3%) in the AHOD1331 trial (enrolled 2015-2019), and 6.2% (95% CI, 2.7%-10.9%) in the S1826 trial (enrolled 2019-2022), whereas the expected rate in an untreated population was 5.0% (95% CI, 2.1%-9.3%). Despite the estimated reduction in late cardiac morbidity, the frequency of recommended echocardiographic screening among survivors will increase based on current guidelines. Conclusions and Relevance In this cohort study of sequential HL trials, reductions in the proportion of children receiving mediastinal RT and increases in dexrazoxane use were estimated to offset the increased doxorubicin dose and produce a net reduction in late cardiac disease. Further studies on dexrazoxane are warranted to confirm whether its role in reducing cardiac toxic effects is maintained long term. These findings suggest that survivorship follow-up guidelines should be refined to align with the risks associated with treatment.
Collapse
Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qi Liu
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute and Oishei Children's Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Alex F Hererra
- Department of Hematology, City of Hope, Duarte, California
| | | | - Debra L Friedman
- Division of Pediatric Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cindy L Schwartz
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville
| | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, Rhode Island
| | | | - Hitesh Dama
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kenneth Roberts
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Louis S Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - David C Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Shell D. Cardiac surgery for radiation associated heart disease in Hodgkin lymphoma patients. Best Pract Res Clin Haematol 2023; 36:101515. [PMID: 38092474 DOI: 10.1016/j.beha.2023.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 12/18/2023]
Abstract
Much of the modern focus of Hodgkin's Lymphoma (HL) treatment involves the prevention of secondary organ injury. Despite rationalisations of radiotherapy fields, many patients still develop late radiation-related cardiotoxicity that is severe and requires interventional management. No guidelines exist to direct management of these complex patients who often present with multiple concurrent cardiac pathologies. Despite possessing a greater mortality risk than in the general population, cardiac surgery has an important role in treating radiation-associated heart disease. This review summarises the body of literature surrounding cardiac surgery in HL survivors post-radiotherapy, highlighting the benefits and risks unique to this cohort. The pathophysiology and presentation of radiation-associated heart disease is also explored in relation to HL patients.
Collapse
Affiliation(s)
- Daniel Shell
- Department of Cardiothoracic Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
| |
Collapse
|
12
|
Aleman BMP, Ricardi U, van der Maazen RWM, Meijnders P, Beijert M, Boros A, Izar F, Janus CPM, Levis M, Martin V, Specht L, Corning C, Clementel E, Raemaekers JM, André MP, Federico M, Fortpied C, Girinsky T. A Quality Control Study on Involved Node Radiation Therapy in the European Organisation for Research and Treatment of Cancer/Lymphoma Study Association/Fondazione Italiana Linfomi H10 Trial on Stages I and II Hodgkin Lymphoma: Lessons Learned. Int J Radiat Oncol Biol Phys 2023; 117:664-674. [PMID: 37179034 DOI: 10.1016/j.ijrobp.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Involved node radiation therapy (INRT) was introduced in the European Organisation for Research and Treatment of Cancer/Lymphoma Study Association/Fondazione Italiana Linfomi H10 trial, a large multicenter trial in early-stage Hodgkin Lymphoma. The present study aimed to evaluate the quality of INRT in this trial. METHODS AND MATERIALS A retrospective, descriptive study was initiated to evaluate INRT in a representative sample encompassing approximately 10% of all irradiated patients in the H10 trial. Sampling was stratified by academic group, year of treatment, size of the treatment center, and treatment arm, and it was done proportional to the size of the strata. The sample was completed for all patients with known recurrences to enable future research on relapse patterns. Radiation therapy principle, target volume delineation and coverage, and applied technique and dose were evaluated using the EORTC Radiation Therapy Quality Assurance platform. Each case was reviewed by 2 reviewers and, in case of disagreement also by an adjudicator for a consensus evaluation. RESULTS Data were retrieved for 66 of 1294 irradiated patients (5.1%). Data collection and analysis were hampered more than anticipated by changes in archiving of diagnostic imaging and treatment planning systems during the running period of the trial. A review could be performed on 61 patients. The INRT principle was applied in 86.6%. Overall, 88.5% of cases were treated according to protocol. Unacceptable variations were predominately due to geographic misses of the target volume delineations. The rate of unacceptable variations decreased during trial recruitment. CONCLUSIONS The principle of INRT was applied in most of the reviewed patients. Almost 90% of the evaluated patients were treated according to the protocol. The present results should, however, be interpreted with caution because the number of patients evaluated was limited. Individual case reviews should be done in a prospective fashion in future trials. Radiation therapy Quality Assurance tailored to the clinical trial objectives is strongly recommended.
Collapse
Affiliation(s)
- Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
| | | | | | - Paul Meijnders
- Department of Radiotherapy, Iridium Network, Centre for Oncological Research of the University of Antwerp, Antwerp, Belgium
| | - Max Beijert
- Department of Radiotherapy, University Medical Center Groningen, Groningen, Netherlands
| | - Angela Boros
- Radiation Oncology Department, Center Hospitalier Lyon Sud, Pierre Benite, France
| | - Françoise Izar
- Department of Radiotherapy, Institut universitaire du cancer de Toulouse, Toulouse, France
| | - Cécile P M Janus
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Mario Levis
- Department of Oncology, University of Turin, Turin, Italy
| | - Valentine Martin
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Coreen Corning
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Enrico Clementel
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - John M Raemaekers
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | - Marc P André
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | - Massimo Federico
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Catherine Fortpied
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Theodore Girinsky
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| |
Collapse
|
13
|
Harmeling JX, Woerdeman LAE, Ozdemir E, Schaapveld M, Oldenburg HSA, Janus CPM, Russell NS, Koppert LB, Krul IM, van Leeuwen FE, Mureau MAM. Surgical outcomes following breast reconstruction in patients with and without a history of chest radiotherapy for Hodgkin lymphoma: a multicentre, matched cohort study. Int J Surg 2023; 109:2896-2905. [PMID: 37037583 PMCID: PMC10583922 DOI: 10.1097/js9.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/12/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Breast cancer is the most common treatment-related second malignancy among women with previous chest radiotherapy for Hodgkin lymphoma (HL). Little is known about the effects of this kind of radiotherapy on the outcomes of postmastectomy breast reconstruction (BR). This study compared adverse outcomes of BR after HL-related chest radiotherapy to matched controls. METHODS The authors conducted a retrospective, matched cohort study in two expert cancer centres in the Netherlands. BRs after therapeutic or prophylactic mastectomy in HL survivors who received chest radiotherapy were matched with BRs in nonirradiated patients without HL on age at mastectomy date, date of BR, and type of BR. The primary outcome was complication-related BR failure or conversion and secondary outcomes were complication-related re-operation, capsular contracture, major donor-site complications, and complication-related ICU admission. The authors analyzed all outcomes univariably using Fisher's exact tests and the authors assessed reconstruction failure, complication-related re-operation, and capsular contracture with multivariable Cox regression analysis adjusting for confounding and data clustering. RESULTS Seventy BRs in 41 patients who received chest radiotherapy for HL were matched to 121 BRs in 110 nonirradiated patients. Reconstruction failure did not differ between HL survivors (12.9%) and controls (12.4%). The comparison groups showed no differences in number of reoperations, major donor-site complications, or capsular contractures. BR in HL survivors more often let to ICU admission due to complications compared with controls ( P =0.048). CONCLUSIONS We observed no increased risk of adverse outcomes following BR after previous chest radiotherapy for HL. This is important information for counselling these patients and may improve shared decision-making.
Collapse
Affiliation(s)
| | | | - Ezgi Ozdemir
- Departments of Plastic and Reconstructive Surgery
| | - Michael Schaapveld
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Cécile P M Janus
- Radiation Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam
| | | | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam
| | - Inge M Krul
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | |
Collapse
|
14
|
Juul SJ, Rossetti S, Kicinski M, van der Kaaij MAE, Giusti F, Meijnders P, Aleman BMP, Raemaekers JMM, Kluin-Nelemans HC, Spina M, Fermé C, Renaud L, Casasnovas O, Stamatoullas A, André M, Le Bras F, Plattel WJ, Henry-Amar M, Hutchings M, Maraldo MV. Work and education interruption in long-term Hodgkin lymphoma survivors: an analysis among patients from nine EORTC-LYSA trials. Acta Oncol 2023; 62:744-752. [PMID: 37039661 DOI: 10.1080/0284186x.2023.2195561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Disease-specific studies on the impact of Hodgkin lymphoma (HL) on education or work interruption and resumption are lacking. MATERIAL AND METHODS In a cross-sectional study conducted among long-term HL survivors enrolled from 1964 to 2004 in nine randomised EORTC-LYSA trials, the interruption and resumption of education/work was investigated. Survivors alive 5-44 years after diagnosis who were studying or working at time of diagnosis were included (n = 1646). Patient and treatment characteristics were obtained from trial records. Education and work outcomes were collected using the Life Situation Questionnaire. Logistic regression was used to model education or work interruption; Cox regression was used to study resumption rates. RESULTS Among survivors studying at time of diagnosis (n = 323), 52% (95% CI: 46-57%) interrupted their education; however, it was resumed within 24 months by 92% (95% CI: 87-96%). The probability of interruption decreased with time: the more recent the treatment era, the lower the risk (OR 0.70 per 10 years, 95% CI: 0.49-1.01). Treatment with radiotherapy (yes vs. no) was associated with a higher education resumption rate (HR 2.01, 95% CI 1.07-3.78) whereas age, sex, stage, radiotherapy field and chemotherapy were not.Among survivors working at time of diagnosis (n = 1323), 77% (95% CI: 75-79%) interrupted their work. However, it was resumed within 24 months by 86% (95% CI: 84%-88%). Women were more likely to interrupt their work as compared to men (OR 1.90, 95% CI: 1.44-2.51) and, when interrupted, less likely to resume work (HR 0.70, 95% CI: 0.61-0.80). Survivors with a higher educational level were less likely to interrupt their work (OR 0.68 for university vs. no high school, 95% CI: 0.46-1.03); and when interrupted, more likely to resume work (HR 1.50 for university vs. no high school, 95% CI: 1.21-1.86). Increasing age was also associated with lower resumption rates (HR 0.62 for age ≥50 vs. 18-29 years, 95% CI: 0.41-0.94). CONCLUSION An interruption in education/work was common among long-term HL survivors. However, most of the survivors who interrupted their studies or work had resumed their activities within 24 months. In this study, no associations between survivors' characteristics and failure to resume education were observed. Female sex, age ≥50 years, and a lower level of education were found to be associated with not resuming work after treatment for HL.
Collapse
Affiliation(s)
- Sidsel J Juul
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sára Rossetti
- Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | | | - Francesco Giusti
- EORTC Headquarters, Brussels, Belgium (Present affiliation: Belgian Cancer Registry, Brussels, Belgium)
| | - Paul Meijnders
- Department of Radiation Oncology, Iridium Network, University of Antwerp, Antwerpen, Belgium
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - John M M Raemaekers
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele Spina
- Division of Medical Oncology and Immunerelated tumors, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | | | - Loïc Renaud
- AP-HP, Hôpital Saint-Louis, Hemato-oncologie, DMU DHI; Université de Paris, Paris, France
| | | | | | - Marc André
- Department of Hematology, CHU UCL NAMUR, Yvoir, Belgium
| | - Fabien Le Bras
- Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France
| | - Wouter J Plattel
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Centre François Baclesse, Caen, France
| | - Martin Hutchings
- Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maja V Maraldo
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
15
|
Jones DA, Candio P, Shakir R, Ramroth J, Wolstenholme J, Gray AM, Cutter DJ, Ntentas G. Individualised Estimation of Quality-adjusted Survival Benefit and Cost-effectiveness of Proton Beam Therapy in Intermediate-stage Hodgkin Lymphoma. Clin Oncol (R Coll Radiol) 2023; 35:301-310. [PMID: 36732121 DOI: 10.1016/j.clon.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
AIMS Radiotherapy for Hodgkin lymphoma leads to the irradiation of organs at risk (OAR), which may confer excess risks of late effects. Comparative dosimetry studies show that proton beam therapy (PBT) may reduce OAR irradiation compared with photon radiotherapy, but PBT is more expensive and treatment capacity is limited. The purpose of this study is to inform the appropriateness of PBT for intermediate-stage Hodgkin lymphoma (ISHL). MATERIALS AND METHODS A microsimulation model simulating the course of ISHL, background mortality and late effects was used to estimate comparative quality-adjusted life years (QALYs) lived and healthcare costs after consolidative pencil beam scanning PBT or volumetric modulated arc therapy (VMAT), both in deep-inspiration breath-hold. Outcomes were compared for 606 illustrative patients covering a spectrum of clinical presentations, varying by two age strata (20 and 40 years), both sexes, three smoking statuses (never, former and current) and 61 pairs of OAR radiation doses from a comparative planning study. Both undiscounted and discounted outcomes at 3.5% yearly discount were estimated. The maximum excess cost of PBT that might be considered cost-effective by the UK's National Institute for Health and Care Excellence was calculated. RESULTS OAR doses, smoking status and discount rate had large impacts on QALYs gained with PBT. Current smokers benefited the most, averaging 0.605 undiscounted QALYs (range -0.341 to 2.171) and 0.146 discounted QALYs (range -0.067 to 0.686), whereas never smokers benefited the least, averaging 0.074 undiscounted QALYs (range -0.196 to 0.491) and 0.017 discounted QALYs (range -0.030 to 0.086). For the gain in discounted QALYs to be considered cost-effective, PBT would have to cost at most £4812 more than VMAT for current smokers and £645 more for never smokers. This is below preliminary National Health Service cost estimates of PBT over photon radiotherapy. CONCLUSION In a UK setting, PBT for ISHL may not be considered cost-effective. However, the degree of unquantifiable uncertainty is substantial.
Collapse
Affiliation(s)
- D A Jones
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK.
| | - P Candio
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Department of Economics and Management, University of Trento, Trento, Italy
| | - R Shakir
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Ramroth
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - A M Gray
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - D J Cutter
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - G Ntentas
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| |
Collapse
|
16
|
White D, Sadough Shahmirzadi M, Boulmay B. Multi-Phenotypic Breast Cancer Post-Radiotherapy for Hodgkin Lymphoma: A Case of Secondary Malignancy. J Investig Med High Impact Case Rep 2023; 11:23247096231188251. [PMID: 37480256 PMCID: PMC10363863 DOI: 10.1177/23247096231188251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/14/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023] Open
Abstract
Morbidity and mortality associated with radiation-induced secondary malignancies (RISMs) have shifted treatment paradigms to minimize or eliminate radiation from treatment regimens. In this case, a 48-year-old woman was diagnosed with Hodgkin lymphoma (HL) and treated with radiotherapy in 2000. In 2018, she was diagnosed with ductal carcinoma in situ (DCIS) of the right breast and treated with a mastectomy. Soon after, she developed triple-negative invasive ductal carcinoma (IDC) in her reconstructed breast. The patient underwent a left lumpectomy, and pathology showed ER-/PR-/HER2+ IDC. This patient's multi-phenotypic DCIS and IDC presentation are suspected to be RISM due to her previous HL treatment regimen.
Collapse
Affiliation(s)
- Donnell White
- Louisiana State University Health Sciences Center New Orleans, USA
| | | | - Brian Boulmay
- Louisiana State University Health Sciences Center New Orleans, USA
| |
Collapse
|
17
|
Shaheen H, Zaghloul MS, Ammar H, Aly B, Hassanin E, Mohsen SAE, Ahmed S. Voluntary deep inspiration breath-hold with volumetric modulated arc therapy in pediatric patients with mediastinal Hodgkin lymphoma. Future Oncol 2023; 19:137-145. [PMID: 36919855 DOI: 10.2217/fon-2022-0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Deep inspiration breath-hold (DIBH) has been established to decrease normal tissue radiation dose in breast cancer. Methods: Forty-nine patients had two CT scans during DIBH or free breathing. Chest-wall position, setup verification and breath-hold monitoring were performed. Cone-beam CT and a surface image system were used for verification. Results: A total of 1617 breath-holds were analyzed in 401 fractions. The mean time bit was 6.01 min. The mean breaths-holds per fraction was 4.96. The median for intra-breath hold variability was 3 mm. No patient stopped treatment for intolerance. Clinical target volume margins were calculated as 0.36, 0.36 and 0.32 for the three translational positions. The mean saved volume was 26.3%. Conclusion: Voluntary DIBH is feasible, tolerable and easy to apply for children with Hodgkin lymphoma involving the mediastinum.
Collapse
Affiliation(s)
- Haitham Shaheen
- Clinical Oncology Department, Suez Canal University, Ismailia, Egypt
- Children Cancer Hospital Egypt, 57357, Cairo, Egypt
| | - Mohamed S Zaghloul
- Children Cancer Hospital Egypt, 57357, Cairo, Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hany Ammar
- Children Cancer Hospital Egypt, 57357, Cairo, Egypt
- Clinical Oncology Department, Aswan University, Aswan, Egypt
| | - Bakr Aly
- Children Cancer Hospital Egypt, 57357, Cairo, Egypt
| | - Ehab Hassanin
- Clinical Oncology Department, Suez Canal University, Ismailia, Egypt
| | | | - Soha Ahmed
- Clinical Oncology Department, Suez University, Suez, Egypt
| |
Collapse
|
18
|
Krul IM, Boekel NB, Kramer I, Janus CPM, Krol ADG, Nijziel MR, Zijlstra JM, van der Maazen RWM, Roesink JM, Jacobse JN, Schaapveld M, Schmidt MK, Opstal-van Winden AWJ, Sonke GS, Russell NS, Aleman BMP, van Leeuwen FE. Breast cancer and cardiovascular outcomes after breast cancer in survivors of Hodgkin lymphoma. Cancer 2022; 128:4285-4295. [PMID: 36281718 DOI: 10.1002/cncr.34464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/25/2022] [Accepted: 03/24/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hodgkin lymphoma (HL) survivors treated with chest radiotherapy have an increased risk of breast cancer (BC). Prior HL treatment and associated cardiovascular disease (CVD) risk may limit BC treatment options. It is unknown how treatment adaptations affect BC and CVD outcomes. METHODS The authors compared 195 BC patients treated with chest/axillary radiotherapy for HL (BC-HL) with 5988 age- and calendar year-matched patients with first primary BC (BC-1). Analyses included cumulative incidence functions and Cox regression models, accounting for tumor characteristics and BC treatment. RESULTS Compared to BC-1 patients, BC-HL patients received anthracycline-containing chemotherapy (23.7% vs. 43.8%, p < .001) and breast-conserving surgery followed by radiotherapy (7.1% vs. 57.7%, p < .001) less often. BC treatment considerations were reported for 71% of BC-HL patients. BC-HL patients had a significantly higher risk of 15-year overall mortality than BC-1 patients (61% vs. 23%). Furthermore, risks of BC-specific mortality and nonfatal BC events were significantly increased among BC-HL patients, also when accounting for tumor and treatment characteristics (2.2- to 4.5-fold). BC-HL patients with a screen-detected BC had a significantly reduced (61%) BC-specific mortality. One-third of BC-HL patients had CVD at BC-diagnosis, compared to <0.1% of BC-1 patients. Fifteen-year CVD-specific mortality and CVD incidence were significantly higher in BC-HL patients than in BC-1 patients (15.2% vs. 0.4% and 40.4% vs. 6.8%, respectively), which was due to HL treatment rather than BC treatment. CONCLUSIONS BC-HL patients experience a higher burden of CVD and worse BC outcomes than BC-1 patients. Clinicians should be aware of increased CVD risk when selecting BC treatment for HL survivors. LAY SUMMARY Patients with breast cancer after Hodgkin lymphoma (BC-HL) may have limited options for BC treatment, due to earlier HL treatment and an associated increased risk of cardiovascular disease (CVD). BC treatment considerations were reported for 71% of BC-HL patients. We examined whether BC-HL patients have a higher risk of CVD or BC events (recurrences/metastases) compared to patients with breast cancer that had no earlier tumors (BC-1). We observed a higher burden of CVD and worse BC outcomes in HL patients compared to BC-1 patients. Clinicians should be aware of increased CVD risk when selecting BC treatment for HL survivors.
Collapse
Affiliation(s)
- Inge M Krul
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Naomi B Boekel
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Kramer
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cécile P M Janus
- Department of Radiation Oncology, Erasmus University MC Cancer Institute, Rotterdam, The Netherlands
| | - Augustinus D G Krol
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marten R Nijziel
- Department of Hematology, Catharina Hospital, Eindhoven, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Judith M Roesink
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judy N Jacobse
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marjanka K Schmidt
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Gabe S Sonke
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicola S Russell
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Roschewski M, Bollard CM. Are We Too Reliant on Radiation Therapy for Children with Hodgkin's Lymphoma? N Engl J Med 2022; 387:1710-1712. [PMID: 36322850 DOI: 10.1056/nejme2211587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark Roschewski
- From the Lymphoid Malignancies Branch, Clinical Cancer Research, National Cancer Institute, Bethesda, MD (M.R.); and the Center for Cancer and Immunology Research, Children's National Hospital, and George Washington Cancer Center, George Washington University, Washington, DC (C.M.B.)
| | - Catherine M Bollard
- From the Lymphoid Malignancies Branch, Clinical Cancer Research, National Cancer Institute, Bethesda, MD (M.R.); and the Center for Cancer and Immunology Research, Children's National Hospital, and George Washington Cancer Center, George Washington University, Washington, DC (C.M.B.)
| |
Collapse
|
20
|
Parekh A, Keller FG, McCarten KM, Kessel S, Cho S, Pei Q, Wu Y, Castellino SM, Constine LS, Schwartz CL, Hodgson D, Kelly KM, Hoppe BS. Targeted radiotherapy for early-stage, low-risk pediatric Hodgkin lymphoma slow early responders: a COG AHOD0431 analysis. Blood 2022; 140:1086-1093. [PMID: 35763667 PMCID: PMC9461469 DOI: 10.1182/blood.2022016098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/12/2022] [Indexed: 11/20/2022] Open
Abstract
Children's Oncology Group (COG) trial AHOD0431 reduced systemic therapy and used response-adapted involved-field radiotherapy (IFRT) in early-stage pediatric classic Hodgkin lymphoma. We investigated the impact of positron emission tomographic response after 1 cycle (PET1) and on IFRT outcomes and pattern of relapse. Patients in AHOD0431 underwent PET1 response assessment after AVPC (doxorubicin, vincristine, prednisone, and cyclophosphamide). "Rapid early responders" (RERs) had a negative PET1 (PET1-); "slow early responders" (SERs) had a positive PET1 (PET1+). Patients with a partial response by computed tomographic and functional imaging after 3 chemotherapy cycles received 21-Gy IFRT, whereas complete responders had no IFRT. Progression-free survival (PFS) was evaluated for RERs and SERs treated with or without IFRT. Recurrence sites were initial, new, or both. Relapses involving initial sites were characterized as "within the PET1+ site" or "initially involved but outside the PET1+ site." Median follow-up was 118 months. The 10-year PFS rate among RERs was 96.6% with IFRT and 84.1% without IFRT (P = .10), whereas SERs were 80.9% with IFRT and 64.0% without IFRT (P = .03). Among 90 RERs who did not receive IFRT, all 14 relapses included an initial site. Among 45 SERs receiving no IFRT, 14 of 16 relapses were in the initial site (9 PET1+ site only). Among 58 patients receiving IFRT, 5 of 10 relapses were in the PET1+ site. After 3 cycles of AVPC alone, RERs showed favorable results. Conversely, SERs had unfavorable outcomes with AVPC alone, although they improved with 21-Gy IFRT. RT remains an important component of treatment for SERs. This trial was registered at www.clinicaltrials.gov as #NCT00302003.
Collapse
Affiliation(s)
- Akash Parekh
- Department of Radiation Oncology, University of Florida, Gainesville, FL
| | - Frank G Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | | | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, RI
| | - Steve Cho
- Nuclear Medicine Section, Department of Radiobiology, University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI
| | - Qinglin Pei
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL
| | - Yue Wu
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Cindy L Schwartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; and
| | | |
Collapse
|
21
|
Roberts WC, Jeong M. Massive Calcification of the Ascending Aorta Secondary to Irradiation for Hodgkin's Disease Decades Earlier in Association with Aortic Valve Stenosis. Am J Cardiol 2022; 175:170-174. [PMID: 35606176 DOI: 10.1016/j.amjcard.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/08/2022] [Indexed: 11/15/2022]
Abstract
Described herein are findings in 2 men who developed massively calcified non-dilated ascending aortas decades after receiving mediastinal irradiation for treatment of Hodgkin's disease associated with aortic valve stenosis. The quantity of the intimal aortic calcium was remarkable and much greater than in other aortic conditions. The ascending aorta had to be excised in one patient in order to replace the stenotic aortic valve. The other patient underwent percutaneous transluminal aortic valve implantation.
Collapse
Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Departments of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Departments of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Minseob Jeong
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| |
Collapse
|
22
|
Li B, Liu Y, Lou Z, Zhang W, Zhang M, Liu Q. Radiotherapy-induced isolated left main coronary artery disease presenting with cardiogenic shock: A case report. Medicine (Baltimore) 2022; 101:e29116. [PMID: 35482983 PMCID: PMC9276303 DOI: 10.1097/md.0000000000029116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Mediastinal radiotherapy is a common practice for treating breast cancer and Hodgkin's lymphoma. Radiotherapy causes cardiovascular damage and has attracted increasing attention, particularly among Hodgkin's lymphoma patients, as they receive a higher dose of radiation. PATIENT CONCERNS A 36-year-old woman with a past medical history of Hodgkin's lymphoma presented with persistent chest pain for 3 hours. She experienced exertional chest pain 1 month before when she was climbing stairs, which disappeared after a few minutes with rest, but recurred with a similar level of exertion. Three hours before admission to the emergency room, the chest pain persisted and was accompanied by diaphoresis and dyspnea. DIAGNOSIS Cardiogenic shock caused by radiotherapy-induced left main coronary artery disease. INTERVENTIONS Urgent angiography revealed left main coronary artery stenosis. Intravascular ultrasonography showed diffuse fibrous proliferation in the left main coronary artery. Hemodynamic instability was resolved after drug-eluting stent implantation. OUTCOMES The patient was discharged uneventfully 5 days after the procedure, with a prescription for dual antiplatelet and statin therapy. She was asymptomatic with good exercise tolerance at the 3-month follow-up. CONCLUSION Radiotherapy-induced isolated left main coronary artery disease is a rare complication of cancer radiotherapy and can occur years or decades after treatment. Fibrous proliferation is a characteristic pathologic change in the exposed coronary arteries.
Collapse
|
23
|
Ntentas G, Dedeckova K, Andrlik M, Aznar MC, Shakir R, Ramroth J, Begum R, Kubeš J, Darby SC, Mikhaeel NG, Cutter DJ. Proton Therapy in Supradiaphragmatic Lymphoma: Predicting Treatment-Related Mortality to Help Optimize Patient Selection. Int J Radiat Oncol Biol Phys 2022; 112:913-925. [PMID: 34762970 PMCID: PMC8865523 DOI: 10.1016/j.ijrobp.2021.10.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE In some patients with Hodgkin lymphoma (HL), proton beam therapy (PBT) may reduce the risk of radiation-related cardiovascular disease (CVD) and second cancers (SC) compared with photon radiation therapy (RT). Our aim was to identify patients who benefit the most from PBT in terms of predicted 30-year absolute mortality risks (AMR30) from CVD and SC, taking into account individual background, chemotherapy, radiation, and smoking-related risks. METHODS AND MATERIALS Eighty patients with supradiaphragmatic HL treated with PBT between 2015 and 2019 were replanned using optimal photon RT. To identify patients predicted to derive the greatest benefit from PBT compared with photon RT, doses and AMR30 from CVD and SC of the lung, breast, and esophagus were compared for all patients and across patient subgroups. RESULTS For patients with mediastinal disease below the origin of the left main coronary artery (n = 66; 82%), PBT reduced the mean dose to the heart, left ventricle, and heart valves by 1.0, 2.7, and 3.6 Gy, respectively. Based on U.S. mortality rates, PBT reduced CVD AMR30 by 0.2%, from 5.9% to 5.7%. The benefit was larger if the mediastinal disease overlapped longitudinally with the heart by ≥40% (n = 23; 29%). PBT reduced the mean dose to the heart, left ventricle, and heart valves by 3.2, 5.6, and 5.1 Gy, respectively, and reduced CVD AMR30 by 0.8%, from 7.0% to 6.2%. For patients with axillary disease (n = 25; 31%), PBT reduced the mean lung dose by 2.8 Gy and lung cancer AMR30 by 0.6%, from 2.7% to 2.1%. Breast and esophageal doses were also lower with PBT, but the effects on AMR30 were negligible. The effect of smoking on CVD and lung cancer AMR30 was much larger than radiation and chemotherapy and the differences between radiation modalities. CONCLUSIONS The predicted benefit of PBT is not universal and limited to certain categories of patients with lymphoma and lower mediastinal or axillary disease. Smoking cessation should be strongly encouraged in smokers who require thoracic RT.
Collapse
Affiliation(s)
- Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, United Kingdom.
| | - Katerina Dedeckova
- Proton Therapy Center Czech, Prague, Czech Republic; Department of Oncology, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | - Marianne C Aznar
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - Rebecca Shakir
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Johanna Ramroth
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Rubina Begum
- Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, United Kingdom
| | - Jiří Kubeš
- Proton Therapy Center Czech, Prague, Czech Republic; Department of Oncology, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - N George Mikhaeel
- Guy's & St Thomas' NHS Foundation Trust and School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - David J Cutter
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| |
Collapse
|
24
|
Mauz-Körholz C, Landman-Parker J, Balwierz W, Ammann RA, Anderson RA, Attarbaschi A, Bartelt JM, Beishuizen A, Boudjemaa S, Cepelova M, Claviez A, Daw S, Dieckmann K, Fernández-Teijeiro A, Fosså A, Gattenlöhner S, Georgi T, Hjalgrim LL, Hraskova A, Karlén J, Kluge R, Kurch L, Leblanc T, Mann G, Montravers F, Pears J, Pelz T, Rajić V, Ramsay AD, Stoevesandt D, Uyttebroeck A, Vordermark D, Körholz D, Hasenclever D, Wallace WH. Response-adapted omission of radiotherapy and comparison of consolidation chemotherapy in children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma (EuroNet-PHL-C1): a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial. Lancet Oncol 2022; 23:125-137. [PMID: 34895479 PMCID: PMC8716340 DOI: 10.1016/s1470-2045(21)00470-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma achieve an event-free survival at 5 years of about 90% after treatment with vincristine, etoposide, prednisone, and doxorubicin (OEPA) followed by cyclophosphamide, vincristine, prednisone, and procarbazine (COPP) and radiotherapy, but long-term treatment effects affect survival and quality of life. We aimed to investigate whether radiotherapy can be omitted in patients with morphological and metabolic adequate response to OEPA and whether modified consolidation chemotherapy reduces gonadotoxicity. METHODS Our study was designed as a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial, and was carried out at 186 hospital sites across 16 European countries. Children and adolescents with newly diagnosed intermediate-stage (treatment group 2) and advanced-stage (treatment group 3) classical Hodgkin lymphoma who were younger than 18 years and stratified according to risk using Ann Arbor disease stages IIAE, IIB, IIBE, IIIA, IIIAE, IIIB, IIIBE, and all stages IV (A, B, AE, and BE) were included in the study. Patients with early disease (treatment group 1) were excluded from this analysis. All patients were treated with two cycles of OEPA (1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1, 8, and 15; 125 mg/m2 etoposide taken intravenously on days 1-5; 60 mg/m2 prednisone taken orally on days 1-15; and 40 mg/m2 doxorubicin taken intravenously on days 1 and 15). Patients were randomly assigned to two (treatment group 2) or four (treatment group 3) cycles of COPP (500 mg/m2 cyclophosphamide taken intravenously on days 1 and 8; 1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1 and 8; 40 mg/m2 prednisone taken orally on days 1 to 15; and 100 mg/m2 procarbazine taken orally on days 1 to 15) or COPDAC, which was identical to COPP except that 250 mg/m2 dacarbazine administered intravenously on days 1 to 3 replaced procarbazine. The method of randomisation (1:1) was minimisation with stochastic component and was centrally stratified by treatment group, country, trial sites, and sex. The primary endpoint was event-free survival, defined as time from treatment start until the first of the following events: death from any cause, progression or relapse of classical Hodgkin lymphoma, or occurrence of secondary malignancy. The primary objectives were maintaining 90% event-free survival at 5 years in patients with adequate response to OEPA treated without radiotherapy and to exclude a decrease of 8% in event-free survival at 5 years in the embedded COPDAC versus COPP randomisation to show non-inferiority of COPDAC. Efficacy analyses are reported per protocol and safety in the intention-to-treat population. The trial is registered with ClinicalTrials.gov (trial number NCT00433459) and EUDRACT (trial number 2006-000995-33), and is closed to recruitment. FINDINGS Between Jan 31, 2007, and Jan 30, 2013, 2102 patients were recruited. 737 (35%) of the 2102 recruited patients were in treatment group 1 (early-stage disease) and were not included in our analysis. 1365 (65%) of the 2102 patients were in treatment group 2 (intermediate-stage disease; n=455) and treatment group 3 (advanced-stage disease; n=910). Of these 1365, 1287 (94%) patients (435 [34%] of 1287 in treatment group 2 and 852 [66%] of 1287 in treatment group 3) were included in the titration trial per-protocol analysis. 937 (69%) of 1365 patients were randomly assigned to COPP (n=471) or COPDAC (n=466) in the embedded trial. Median follow-up was 66·5 months (IQR 62·7-71·7). Of 1287 patients in the per-protocol group, 514 (40%) had an adequate response to treatment and were not treated with radiotherapy (215 [49%] of 435 in treatment group 2 and 299 [35%] of 852 in treatment group 3). 773 (60%) of 1287 patients with inadequate response were scheduled for radiotherapy (220 [51%] of 435 in the treatment group 2 and 553 [65%] of 852 in treatment group 3. In patients who responded adequately, event-free survival rates at 5 years were 90·1% (95% CI 87·5-92·7). event-free survival rates at 5 years in 892 patients who were randomly assigned to treatment and analysed per protocol were 89·9% (95% CI 87·1-92·8) for COPP (n=444) versus 86·1% (82·9-89·4) for COPDAC (n=448). The COPDAC minus COPP difference in event-free survival at 5 years was -3·7% (-8·0 to 0·6). The most common grade 3-4 adverse events (intention-to-treat population) were decreased haemoglobin (205 [15%] of 1365 patients during OEPA vs 37 [7%] of 528 treated with COPP vs 20 [2%] of 819 treated with COPDAC), decreased white blood cells (815 [60%] vs 231 [44%] vs 84 [10%]), and decreased neutrophils (1160 [85%] vs 223 [42%] vs 174 [21%]). One patient in treatment group 2 died of sepsis after the first cycle of OEPA; no other treatment-related deaths occurred. INTERPRETATION Our results show that radiotherapy can be omitted in patients who adequately respond to treatment, when consolidated with COPP or COPDAC. COPDAC might be less effective, but is substantially less gonadotoxic than COPP. A high proportion of patients could therefore be spared radiotherapy, eventually reducing the late effects of treatment. With more refined criteria for response assessment, the number of patients who receive radiotherapy will be further decreased. FUNDING Deutsche Krebshilfe, Elternverein für Krebs-und leukämiekranke Kinder Gießen, Kinderkrebsstiftung Mainz, Tour der Hoffnung, Menschen für Kinder, Programme Hospitalier de Recherche Clinique, and Cancer Research UK.
Collapse
Affiliation(s)
- Christine Mauz-Körholz
- Department of Paediatric Oncology, Justus-Liebig- University Giessen, Giessen, Germany; Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Judith Landman-Parker
- Department of Paediatric Haematology-Oncology, Sorbonne Université and APHP-SIRIC CURAMUS Hôpital a Trousseau, Paris, France
| | - Walentyna Balwierz
- Department of Paediatric Oncology and Haematology, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Roland A Ammann
- Paediatric Haematology and Oncology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern Switzerland
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andische Attarbaschi
- Department of Paediatric Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jörg M Bartelt
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - Auke Beishuizen
- Princess Máxima Centre for Paediatric Oncology, Utrecht and Erasmus, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabah Boudjemaa
- Department of Pathology, Armand Trousseau Hospital, Paris, France
| | - Michaela Cepelova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Alexander Claviez
- Department of Paediatrics, University of Schleswig-Holstein, Kiel, Germany
| | - Stephen Daw
- Children and Young People's Cancer Service, University College Hospital London, London, UK
| | - Karin Dieckmann
- Strahlentherapie AKH Wien Medizinische, Universitätsklinik Wien, Vienna, Austria
| | | | | | | | - Thomas Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lisa L Hjalgrim
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Hraskova
- Department of Paediatric Haematology and Oncology, National Institute of Children's Disease and Comenius University, Bratislava, Slovakia
| | - Jonas Karlén
- Department of Paediatric Oncology at Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Thiery Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Georg Mann
- St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Francoise Montravers
- Department of Nuclear Medicine, Tenon Hospital, APHP and Sorbonne Université, Paris, France
| | - Jean Pears
- Our Lady's Hospital for Children's Health, Dublin, Ireland
| | - Tanja Pelz
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Vladan Rajić
- Clinical Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, University Medical Centre Ljubljana and University Children's Hospital, Ljubljana, Slovenia
| | - Alan D Ramsay
- Department of Cellular Pathology, University College Hospital London, London, UK
| | | | - Anne Uyttebroeck
- Paediatric Haematology and Oncology, Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig- University Giessen, Giessen, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - William Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People and University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
25
|
Epperla N, Hamadani M. Double-refractory Hodgkin lymphoma: tackling relapse after brentuximab vedotin and checkpoint inhibitors. Hematology Am Soc Hematol Educ Program 2021; 2021:247-253. [PMID: 34889401 PMCID: PMC8791097 DOI: 10.1182/hematology.2021000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The approval of brentuximab vedotin (BV) and checkpoint inhibitors (CPI) has revolutionized the management of relapsed/refractory classical Hodgkin lymphoma (cHL) patients. In recent years these agents have rapidly moved to earlier lines of therapy, including post-autologous hematopoietic cell transplant (auto-HCT) consolidation, pre-HCT salvage, and the frontline treatment setting. This shift in practice means that double-refractory (refractory to both BV and CPI) cHL is becoming an increasingly common clinical problem. In patients who are not eligible for clinical trials, conventional cytotoxic and targeted therapies (off label) may be a potential option. In patients who are transplant eligible, early referral to allogeneic HCT should be considered given the significant improvement in transplant outcomes in the contemporary era. Cellular therapy options including CD30.chimeric antigen receptor T cells, Epstein-Barr virus-directed cytotoxic T cells, and CD16A/30 bispecific natural killer cell engagers appear promising and are currently in clinical trials.
Collapse
Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, Ohio State University, Columbus, OH
| | - Mehdi Hamadani
- Blood and Marrow Transplant Program and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
26
|
Driessen J, Tonino SH, Moskowitz AJ, Kersten MJ. How to choose first salvage therapy in Hodgkin lymphoma: traditional chemotherapy vs novel agents. Hematology Am Soc Hematol Educ Program 2021; 2021:240-246. [PMID: 34889399 PMCID: PMC8791111 DOI: 10.1182/hematology.2021000311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Approximately 10% to 30% of patients with classical Hodgkin lymphoma (cHL) develop relapsed or refractory (R/R) disease. Of those patients, 50% to 60% show long-term progression-free survival after standard salvage chemotherapy followed by high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). In the past decade, novel therapies have been developed, such as the CD30-directed antibody-drug conjugate brentuximab vedotin and immune checkpoint inhibitors, which have greatly extended the treatment possibilities for patients with R/R cHL. Several phase 1/2 clinical trials have shown promising results of these new drugs as monotherapy or in combination with chemotherapy, but unfortunately, very few randomized phase 3 trials have been performed in this setting, making it difficult to give evidence-based recommendations for optimal treatment sequencing. Two important goals for the improvement in the treatment of R/R cHL can be identified: (1) increasing long-term progression-free and overall survival by optimizing risk-adapted treatment and (2) decreasing toxicity in patients with a low risk of relapse of disease by evaluating the need for HDCT/ASCT in these patients. In this review, we discuss treatment options for patients with R/R cHL in different settings: patients with a first relapse, primary refractory disease, and in patients who are ineligible or unfit for ASCT. Results of clinical trials investigating novel therapies or strategies published over the past 5 years are summarized.
Collapse
Affiliation(s)
- Julia Driessen
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Sanne H Tonino
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alison J Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Baues C, Goergen H, Fuchs M, Rosenbrock J, Celik E, Eich H, Kobe C, Voltin CA, Engert A, Borchmann P, Marnitz S. 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 2021; 111:900-906. [PMID: 34389407 DOI: 10.1016/j.ijrobp.2021.07.1697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
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 incidence 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 demonstrated 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.
Collapse
Affiliation(s)
- Christian Baues
- Department of Radiooncology, Radiotherapy and Cyberknife Center; German Hodgkin Study Group (GHSG).
| | | | - Michael Fuchs
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Johannes Rosenbrock
- Department of Radiooncology, Radiotherapy and Cyberknife Center; German Hodgkin Study Group (GHSG)
| | - Eren Celik
- Department of Radiooncology, Radiotherapy and Cyberknife Center
| | - Hans Eich
- German Hodgkin Study Group (GHSG); Department of Radiotherapy, University Hospital of Muenster, Muenster, Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG); Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Simone Marnitz
- Department of Radiooncology, Radiotherapy and Cyberknife Center; German Hodgkin Study Group (GHSG)
| |
Collapse
|
28
|
Modiri A, Vogelius I, Rechner LA, Nygård L, Bentzen SM, Specht L. Outcome-based multiobjective optimization of lymphoma radiation therapy plans. Br J Radiol 2021; 94:20210303. [PMID: 34541859 PMCID: PMC8553178 DOI: 10.1259/bjr.20210303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 02/04/2023] Open
Abstract
At its core, radiation therapy (RT) requires balancing therapeutic effects against risk of adverse events in cancer survivors. The radiation oncologist weighs numerous disease and patient-level factors when considering the expected risk-benefit ratio of combined treatment modalities. As part of this, RT plan optimization software is used to find a clinically acceptable RT plan delivering a prescribed dose to the target volume while respecting pre-defined radiation dose-volume constraints for selected organs at risk. The obvious limitation to the current approach is that it is virtually impossible to ensure the selected treatment plan could not be bettered by an alternative plan providing improved disease control and/or reduced risk of adverse events in this individual. Outcome-based optimization refers to a strategy where all planning objectives are defined by modeled estimates of a specific outcome's probability. Noting that various adverse events and disease control are generally incommensurable, leads to the concept of a Pareto-optimal plan: a plan where no single objective can be improved without degrading one or more of the remaining objectives. Further benefits of outcome-based multiobjective optimization are that quantitative estimates of risks and benefit are obtained as are the effects of choosing a different trade-off between competing objectives. Furthermore, patient-level risk factors and combined treatment modalities may be integrated directly into plan optimization. Here, we present this approach in the clinical setting of multimodality therapy for malignant lymphoma, a malignancy with marked heterogeneity in biology, target localization, and patient characteristics. We discuss future research priorities including the potential of artificial intelligence.
Collapse
Affiliation(s)
- Arezoo Modiri
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Ivan Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Ann Rechner
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Nygård
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Lena Specht
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
29
|
Abstract
Classical Hodgkin lymphoma is one of the more frequent lymphomas and is generally considered a highly curable disease with standard first-line chemotherapy and radiotherapy in some cases. Despite these outstanding results, major problems remain unresolved. First, there are still patients who will not be cured with front-line regimens and, second, many patients who are cured of classical Hodgkin lymphoma continue to die prematurely due to the late toxic effects of their therapy. Because the median age of patients with classical Hodgkin lymphoma is in the mid-30s, the disease's impact on the number of years lost from productive life is remarkable. In recent years, the gold standard of chemotherapy (often combined with radiotherapy) has changed, with the approval of immunotherapy mostly in relapse settings.
Collapse
Affiliation(s)
- Pauline Brice
- Department of Oncohaematology, Hôpital saint Louis APHP, Université Paris 7, Paris, France.
| | - Eric de Kerviler
- Department of Radiology, Hôpital saint Louis APHP, Université Paris 7, Paris, France
| | | |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B cell-derived malignancy. This review aims at providing an overview of recent developments in the management of NLPHL. RECENT FINDINGS Patients with stage IA NLPHL without risk factors have excellent outcomes. The 8-year progression-free survival (PFS) is roughly 90% and the 8-year overall survival (OS) close to 100% after limited-field radiotherapy (RT) alone. Individuals presenting with early stages other than stage IA without risk factors and intermediate stages have 10-year PFS rates in excess of 70% and 10-year OS rates exceeding 90% when treated with 2 and 4 cycles of ABVD, respectively, followed by consolidation RT. In advanced NLPHL, different protocols such as BEACOPP, ABVD, and R-CHOP have been evaluated retrospectively. However, the optimal approach is undefined. Patients with relapsed NLPHL mostly receive single-agent anti-CD20 antibody treatment or conventional chemotherapy. High-dose chemotherapy and autologous stem cell transplantation are restricted to high-risk patients. NLPHL recurrence is salvaged successfully in the majority of cases. SUMMARY Patients with NLPHL have a very good prognosis. Treatment differs from classical Hodgkin lymphoma in some situations.
Collapse
Affiliation(s)
- Dennis A Eichenauer
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Andreas Engert
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
31
|
Milgrom SA, Kim J, Chirindel A, Kim J, Pei Q, Chen L, Buxton A, Kessel S, Leal J, McCarten KM, Hoppe BS, Wolden SL, Schwartz CL, Friedman DL, Kelly KM, Cho SY. Prognostic value of baseline metabolic tumor volume in children and adolescents with intermediate-risk Hodgkin lymphoma treated with chemo-radiation therapy: FDG-PET parameter analysis in a subgroup from COG AHOD0031. Pediatr Blood Cancer 2021; 68:e29212. [PMID: 34245210 PMCID: PMC8809108 DOI: 10.1002/pbc.29212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL). MATERIALS AND METHODS Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children's Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS). RESULTS From the AHOD0031 cohort (n = 1712), 86 patients were identified who (i) were treated with four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy followed by involved field radiotherapy, and (ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, six PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e., highest 15%) to the remainder of the cohort. EFS was significantly associated with all six PET parameters (all p < .029). In a multivariable model controlling for important covariates including disease bulk and response to chemotherapy, MTV2BP was significantly associated with EFS (p = .012). CONCLUSION Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV2BP was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL.
Collapse
Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA
| | - Jihyun Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Alin Chirindel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jongho Kim
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Lu Chen
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Allen Buxton
- Children's Oncology Group, Statistics and Data Center, Monrovia, California, USA
| | - Sandy Kessel
- Imaging and Radiation Oncology Core Group, Lincoln, Rhode Island, USA
| | - Jeffrey Leal
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cindy L Schwartz
- Division of Pediatric Hematology, Oncology, and BMT, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Debra L Friedman
- Division of Pediatric Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Steve Y Cho
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| |
Collapse
|
32
|
Gillman AS, Vo JB, Nohria A, Ferrer RA. Decision Science Can Inform Clinical Trade-Offs Regarding Cardiotoxic Cancer Treatments. JNCI Cancer Spectr 2021; 5:pkab053. [PMID: 34350379 PMCID: PMC8328021 DOI: 10.1093/jncics/pkab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/19/2021] [Accepted: 04/30/2021] [Indexed: 12/22/2022] Open
Abstract
Cancer treatment-related cardiotoxicity (ie, heart failure, coronary artery disease, vascular diseases, arrhythmia) is a growing cancer survivorship concern within oncology practice; heart disease is the leading cause of noncancer death in cancer survivors and surpasses cancer as the leading cause of death for some cancers with higher survival rates. The issue of cardiotoxicity introduces a critical tradeoff that must be acknowledged and reconciled in clinical oncology practice: treating cancer aggressively and effectively in the present vs preventing future cardiotoxicity. Although many cancers must be treated as aggressively as possible, for others, multiple treatment options are available. Yet even when effective and less cardiotoxic treatments are available, they are not always chosen. Wariness to choose equally effective but less cardiotoxic treatment options may result in part from providers' and patients' reliance on "cognitive heuristics," or mental shortcuts that people (including, research shows, medical professionals) use to simplify complex judgments. These heuristics include delay discounting, availability and affect heuristics, and default bias. In the current commentary, we describe relevant research that illuminates how use of heuristics leads to biased medical decision making and translate how this research may apply when the tradeoff between aggressive cancer treatment and preventing future cardiotoxicity is considered. We discuss the implications of these biases in oncology practice, offer potential solutions to reduce bias, and call for future research in this area.
Collapse
Affiliation(s)
- Arielle S Gillman
- Division of Cancer Control and Population Sciences, Cancer Prevention Fellowship Program, Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, Cancer Prevention Fellowship Program, Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Anju Nohria
- Cardio-Oncology Program, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, USA
| | - Rebecca A Ferrer
- Division of Cancer Control and Population Sciences, Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
33
|
Loap P, Goudjil F, Dendale R, Kirova Y. Clinical and technical considerations for mediastinal Hodgkin lymphoma protontherapy based on a single-center early experience. Cancer Radiother 2021; 25:779-785. [PMID: 34275748 DOI: 10.1016/j.canrad.2021.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Protontherapy for mediastinal Hodgkin lymphoma reduces cardiac, lung and breast exposure, which may limit radiation-induced adverse events. While this technique is already widely implemented in the United-States, clinical experience is still limited in France. This study analyses the practice of mediastinal Hodgkin lymphoma protontherapy at the Institut Curie to implement this technique at a larger scale. MATERIALS AND METHODS Data from all mediastinal Hodgkin lymphoma patients from the hematology department of the Institut Curie who were subsequently evaluated at the Protontherapy Center of Orsay (CPO) of Institut Curie for adjuvant protontherapy were retrieved. We analyzed why these patients were ultimately treated with protontherapy or not. RESULTS Between January 2018 and January 2021, twenty mediastinal Hodgkin lymphoma patients from the hematology department of the Institut Curie have been screened for protontherapy at the CPO. Four of them (20%) were ultimately treated with proton beams. Treatment was well tolerated without grade 3-4 adverse events. With a median follow-up of two years, none of these patients relapsed. The others sixteen patients were not treated with protontherapy due to multiple reasons including: lack of treatment room disponibility, accessibility difficulties, psychiatric disorder, and anatomic or dosimetric considerations. CONCLUSION Despite notable dosimetric superiority over photon radiotherapy and excellent clinical tolerance, lack of availability of protontherapy facilities limit implementation of mediastinal Hodgkin lymphoma protontherapy. Additionally, strict selection criteria must be defined.
Collapse
Affiliation(s)
- P Loap
- Institut Curie, Department of Radiation Oncology, 75005 Paris, France
| | - F Goudjil
- Institut Curie, Department of Radiation Oncology, 75005 Paris, France
| | - R Dendale
- Institut Curie, Department of Radiation Oncology, 75005 Paris, France
| | - Y Kirova
- Institut Curie, Department of Radiation Oncology, 75005 Paris, France.
| |
Collapse
|
34
|
Shibusawa M, Kidoguchi K, Mori J, Tanimoto T. PET-guided omission of radiotherapy in Hodgkin lymphoma. Lancet Oncol 2021; 22:e181. [PMID: 33932378 DOI: 10.1016/s1470-2045(21)00146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Motoharu Shibusawa
- IMS group Shinmatsudo Central General Hospital, Department of Hematology, Chiba, 270-0034, Japan.
| | | | - Jinichi Mori
- Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | | |
Collapse
|
35
|
Iorio GC, Salvestrini V, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on radiation-induced late sequelae: Focus on early-stage mediastinal classical Hodgkin Lymphoma. A critical review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Crit Rev Oncol Hematol 2021; 161:103326. [PMID: 33862247 DOI: 10.1016/j.critrevonc.2021.103326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/07/2021] [Accepted: 03/26/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The historically feared radiation-induced secondary cancers and cardiac toxicities observed among mediastinal classical Hodgkin Lymphoma (cHL) patients may still negatively burden the benefit of radiotherapy among long-term survivors. Modern radiotherapy (RT) delivery techniques, including intensity-modulated RT (IMRT) and deep inspiration breath-hold (DIBH) solutions, are drastically changing this scenario. Results of a literature overview are reported and discussed in this paper. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of organs-at-risk dose-volume metrics linked with radiation-induced toxicities in cHL patients. CONCLUSIONS The scenario of early-stage cHL presents long-life expectancies, thus the goal of treatment should aim at maintaining high cure rates and limiting the onset of late complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.
Collapse
Affiliation(s)
| | - Viola Salvestrini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili, Brescia, Italy
| | - Francesca De Felice
- Department of Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Valerio Nardone
- Department of Radiation Oncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence, Italy
| |
Collapse
|
36
|
Obayashi Y, Sakamoto J, Hamaguchi Y, Hamasaki M, Mima H, Kojima H, Yamasaki S, Okamoto H, Tamura A, Kuroda M, Harita T, Nishiuchi S, Tamaki Y, Enomoto S, Miyake M, Kondo H, Sakaguchi H, Iwakura A, Tamura T. Successful Transcatheter Aortic Valve Implantation in a Patient with Radiation-induced Aortic Stenosis for Mediastinal Hodgkin Lymphoma. Intern Med 2021; 60:1043-1046. [PMID: 33116008 PMCID: PMC8079924 DOI: 10.2169/internalmedicine.5310-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aortic stenosis (AS), a late complication of thoracic radiation therapy for chest lesions, is often coincident with porcelain aorta or hostile thorax. We herein report a 59-year-old man with a history of mediastinal Hodgkin lymphoma treated with radiation therapy but later presenting with heart failure caused by severe AS. Severe calcification in the mediastinum and around the ascending aorta made it difficult to perform surgical aortic valve replacement. The patient therefore underwent transcatheter aortic valve implantation (TAVI). It is important to recognize radiation-induced AS early, now that TAVI is a well-established treatment required by increasing numbers of successfully treated cancer patients.
Collapse
Affiliation(s)
| | | | | | | | - Hibiki Mima
- Department of Cardiology, Tenri Hospital, Japan
| | | | | | | | | | | | | | | | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Japan
| | | | | | | | | | | | | |
Collapse
|
37
|
Giulino-Roth L, Pei Q, Buxton A, Bush R, Wu Y, Wolden SL, Constine LS, Kelly KM, Schwartz CL, Friedman DL. Subsequent malignant neoplasms among children with Hodgkin lymphoma: a report from the Children's Oncology Group. Blood 2021; 137:1449-1456. [PMID: 33512412 PMCID: PMC7976513 DOI: 10.1182/blood.2020007225] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/01/2020] [Indexed: 11/20/2022] Open
Abstract
Survivors of Hodgkin lymphoma (HL) have an increased risk of subsequent malignant neoplasms (SMNs). Response-adapted treatment may decrease this risk by reducing exposure to therapy associated with SMN risk. The Children's Oncology Group study AHOD0031 evaluated response-adapted therapy for children and adolescents with intermediate-risk HL. We report the SMNs among 1711 patients enrolled in AHOD0031. Patients were treated with 4 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide with or without involved-field radiation therapy (RT). Patients with a slow early response to initial chemotherapy were randomized to 2 additional cycles of dexamethasone, etoposide, cisplatin and cytarabine or no additional chemotherapy, and all received RT. At a median follow-up of 7.3 years, an analysis of SMNs was performed. The 10-year cumulative incidence of SMN was 1.3% (95% confidence interval [CI], 0.6-2.0). SMNs included 3 patients with acute myeloid leukemia (AML), 11 with solid tumors, and 3 with non-Hodgkin lymphoma. Sixteen of 17 patients with an SMN had received combined modality therapy. The standardized incidence ratio for SMN was 9.5 (95% CI, 4.5-15.2) with an excess absolute risk of 1.2 per 1000 person-years. The cumulative incidence of SMNs was higher among patients who received RT (P = .037). In multivariate analysis, RT, B symptoms, and race were associated with SMN risk. Given the latency from exposure, we have likely captured all cases of secondary leukemia and myelodysplastic syndrome (MDS). Longer follow-up is needed to determine the risk of solid tumors. Avoidance of RT without sacrificing disease control should remain a goal for future therapeutic approaches. This trial was registered at www.clinicaltrials.gov as #NCT00025259.
Collapse
Affiliation(s)
- Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Qinglin Pei
- Department of Biostatistics, University of Florida, Gainesville, FL
- Children's Oncology Group Statistics and Data Center, Gainesville, FL
| | - Allen Buxton
- Children's Oncology Group Statistics and Data Center, Monrovia, CA
| | - Rizvan Bush
- Children's Oncology Group Statistics and Data Center, Monrovia, CA
| | - Yue Wu
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Louis S Constine
- Department of Radiation Oncology and
- Department of Pediatrics, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Kara M Kelly
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Cindy L Schwartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Debra L Friedman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; and
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| |
Collapse
|
38
|
Nakashima K, Demura Y, Oi M, Tabata M, Tada T, Shiozaki K, Akai M, Ishizuka T. The Association between Malignant Pleural Mesothelioma and Thoracic Radiation Therapy for Hodgkin's Lymphoma: The First Case Report in Japan. Intern Med 2021; 60:771-775. [PMID: 33055477 PMCID: PMC7990650 DOI: 10.2169/internalmedicine.5134-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is mostly observed in patients with a history of asbestos exposure. Although other causes are rare, there are several reports of MPM induced by therapeutic radiation, mainly in Europe and North America. However, no such case has been reported in Japan. We herein report a 50-year-old Japanese woman who developed MPM 25 years after thoracic radiation therapy for Hodgkin's lymphoma. The patient had no history of exposure to asbestos; therefore, her history of radiation therapy was considered to be the cause of MPM. Clinicians should consider secondary MPM in patients with a history of thoracic radiation therapy.
Collapse
Affiliation(s)
- Koki Nakashima
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
- Third department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Yoshiki Demura
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Masahiro Oi
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Mio Tabata
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Toshihiko Tada
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Kohei Shiozaki
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Masaya Akai
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Tamotsu Ishizuka
- Third department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| |
Collapse
|
39
|
Pepper NB, Oertel M, Kittel C, Kröger KJ, Elsayad K, Haverkamp U, Eich HT. Impact of radiation techniques on lung toxicity in patients with mediastinal Hodgkin's lymphoma. Strahlenther Onkol 2021; 197:56-62. [PMID: 32945894 PMCID: PMC7499413 DOI: 10.1007/s00066-020-01682-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/20/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Mediastinal radiotherapy (RT), especially when combined with bleomycin, may result in substantial pulmonary morbidity and mortality. The use of modern RT techniques like intensity-modulated radiotherapy (IMRT) is gaining interest to spare organs at risk. METHODS We evaluated 27 patients who underwent RT for Hodgkin's lymphoma between 2009 and 2013 at our institution. For each patient, three different treatment plans for a 30-Gy involved-field RT (IFRT) were created (anterior-posterior-posterior-anterior setup [APPA], 5‑field IMRT, and 7‑field IMRT) and analyzed concerning their inherent "normal tissue complication probability" (NTCP) for pneumonitis and secondary pulmonary malignancy. RESULTS The comparison of different radiation techniques showed a significant difference in favor of standard APPA (p < 0.01). The risk of lung toxicity was significantly higher in plans using 7‑field IMRT than in plans using 5‑field IMRT. The absolute juxtaposition showed an increase in risk for radiation pneumonitis of 1% for plans using 5‑field IMRT over APPA according to QUANTEC (Quantitative Analyses of Normal Tissue Effects in the Clinic) parameters (Burman: 0.15%) and 2.6% when using 7‑field IMRT over APPA (Burman: 0.7%) as well as 1.6% when using 7‑field IMRT over 5‑field IMRT (Burman: 0.6%). Further analysis showed an increase in risk for secondary pulmonary malignancies to be statistically significant (p < 0.01); mean induction probability for pulmonary malignoma was 0.1% higher in plans using 5‑field IMRT than APPA and 0.19% higher in plans using 7‑field IMRT than APPA as well as 0.09% higher in plans using 7‑field IMRT than 5‑field IMRT. During a median follow-up period of 65 months (95% confidence interval: 53.8-76.2 months), only one patient developed radiation-induced pneumonitis. No secondary pulmonary malignancies have been detected to date. CONCLUSION Radiation-induced lung toxicity is rare after treatment for Hodgkin lymphoma but may be influenced significantly by the RT technique used. In this study, APPA RT plans demonstrated a decrease in potential radiation pneumonitis and pulmonary malignancies. Biological planning using NTCP may have the potential to define personalized RT strategies.
Collapse
Affiliation(s)
- Niklas Benedikt Pepper
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Kai Jannes Kröger
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| |
Collapse
|
40
|
Andersson A, Enblad G, Erlanson M, Johansson AS, Molin D, Tavelin B, Näslund U, Melin B. High risk of cardiovascular side effects after treatment of Hodgkin's lymphoma - is there a need for intervention in long-term survivors? Ups J Med Sci 2021; 126:6117. [PMID: 33889307 PMCID: PMC8043572 DOI: 10.48101/ujms.v126.6117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) patients have a good prognosis after adequate treatment. Previous treatment with mantle field irradiation has been accompanied by an increased long-term risk of cardiovascular disease (CVD). This study identified co-morbidity factors for the development of cardiovascular side effects and initiated an intervention study aimed to decrease morbidity and mortality of CVD in HL survivors. DESIGN Hodgkin lymphoma patients aged ≤45 years diagnosed between 1965 and 1995 were invited to participate. In total, 453 patients completed a questionnaire that addressed co-morbidity factors and clinical symptoms. Of these, 319 accepted to participate in a structured clinical visit. The statistical analyses compared individuals with CVD with those with no CVD. RESULTS Cardiovascular disease was reported by 27.9%. Radiotherapy (odds ratio [OR]: 3.27), hypertension and hypercholesterolemia were shown to be independent risk factors for the development of CVD. The OR for CVD and valve disease in patients who received radiotherapy towards mediastinum was 4.48 and 6.07, respectively. At clinical visits, 42% of the patients were referred for further investigation and 24% of these had a cardiac ultrasound performed due to previously unknown heart murmurs. CONCLUSION Radiotherapy towards mediastinum was an independent risk factor for CVD as well as hypercholesterolemia and hypertension. A reasonable approach as intervention for this cohort of patients is regular monitoring of hypertension and hypercholesterolemia and referral to adequate investigation when cardiac symptoms appear. Broad knowledge about the side effects from radiotherapy in the medical community and well-structured information regarding late side effects to the patients are all reasonable approaches as late effects can occur even 40 years after cancer treatment.
Collapse
Affiliation(s)
- Anne Andersson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Section Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Martin Erlanson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Section Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Björn Tavelin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| |
Collapse
|
41
|
Shah BA, Oh C, Wu SP, Karp JM, Grossbard M, Gerber NK. Radiation Dose Reduction in Early-Stage Hodgkin Lymphoma. Clin Lymphoma Myeloma Leuk 2020; 20:820-829. [PMID: 32800712 DOI: 10.1016/j.clml.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/29/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Treatment for early-stage Hodgkin lymphoma (HL) involves radiotherapy (RT), chemotherapy, or combined modality therapy (CMT). We analyzed reduction of RT dose in CMT, particularly in the context of German Hodgkin Study Group (GHSG) HD10 randomized trial results of 2010. PATIENTS AND METHODS The National Cancer Data Base was queried for patients with stage I-II HL receiving CMT. RT dose and associated characteristics were analyzed. Stage I and absence of B symptoms were used as a surrogate for early-stage favorable disease. RESULTS Of 31,301 patients with stage I-II HL, 11,457 received CMT between 2004 and 2015. Using the surrogate defined above, 1955 patients (17.1%) were classified as having favorable disease. The majority (61.6%) received 30-36 Gy, while 7.0% received 20 Gy. The provision of 20 Gy was more common in stage I patients (12.3% vs. 5.4% in stage II) and at academic facilities (10.8% vs. 6.3%-8.9% at other facilities). Use of 20 Gy (vs. 30-36 Gy) was less likely with thorax site (odds ratio [OR] 0.43 vs. head and neck), stage II disease (OR 0.41), and B symptoms (OR 0.33). Notably, the use of 20 Gy increased dramatically after 2010 (the year of publication of GHSG HD10 trial results), with rates of 12.3% in 2010-2015 versus 0.1% in 2004-2009 (OR 6.3, P < .001). This was even more pronounced in cases of favorable early-stage disease, with 25.5% after 2010 versus 2.8% before 2010 (OR 13.2, P < .001). The use of doses > 36 Gy decreased over a corresponding time period (OR 0.44, P < .001). CONCLUSION Analysis of CMT for patients with early-stage HL demonstrates variability in RT dose, including increasing use of 20 Gy and decreasing use of high doses > 36 Gy.
Collapse
Affiliation(s)
- Bhartesh A Shah
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - Cheongeun Oh
- Department of Population Health: Biostatistics, NYU Langone Health, New York, NY
| | - S Peter Wu
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - Jerome M Karp
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | | | - Naamit K Gerber
- Department of Radiation Oncology, NYU Langone Health, New York, NY.
| |
Collapse
|
42
|
Saha BK, Najmuddin M. A 63-Year Old Woman with a History of Hodgkin's Lymphoma and Incidentally Identified Bilateral Axillary Lymphadenopathy. Am J Med Sci 2020; 361:e35-e36. [PMID: 33250157 DOI: 10.1016/j.amjms.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA.
| | - Mufaddal Najmuddin
- Division of Pathology, Ozarks Medical Center, West Plains, Missouri, USA
| |
Collapse
|
43
|
Silva Ortega S, Peiró Cabrera G, Niveiro de Jaime M, Aranda López FI. [Microglandular adenosis of the breast in a patient with a history of mediastinal radiotherapy]. Rev Esp Patol 2020; 53:254-256. [PMID: 33012496 DOI: 10.1016/j.patol.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/11/2019] [Accepted: 01/02/2020] [Indexed: 06/11/2023]
Abstract
The risk of secondary tumors in patients who have received mediastinal radiation therapy is well-known. Microglandular adenosis of the breast is a rare lesion that is considered benign, although its possible role as a precursor of invasive breast carcinoma has been considered. We present a case of microglandular adenosis in a patient who received mediastinal radiation therapy in childhood for Hodgkin's lymphoma. To our knowledge, this is the first reported case of microglandular adenosis in a patient with mediastinal radiotherapy which may shed light on its pathogenesis.
Collapse
Affiliation(s)
- Sandra Silva Ortega
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Alicante, España.
| | - Gloria Peiró Cabrera
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Alicante, España
| | - María Niveiro de Jaime
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Alicante, España
| | - F Ignacio Aranda López
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Alicante, España
| |
Collapse
|
44
|
Pinnix CC, Gunther JR, Fang P, Bankston ME, Milgrom SA, Boyce D, Lee HJ, Nair R, Steiner R, Strati P, Ahmed S, Iyer SP, Westin J, Parmar S, Rodriguez MA, Nastoupil L, Neelapu S, Flowers C, Dabaja BS. Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy. JAMA Netw Open 2020; 3:e2013935. [PMID: 32990738 PMCID: PMC7525355 DOI: 10.1001/jamanetworkopen.2020.13935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Response-adapted randomized trials have used positron emission tomography-computed tomography to attempt to identify patients with early-stage favorable Hodgkin lymphoma (ESFHL) who could be treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) without radiation therapy (RT). While maximal efficacy is demonstrated with combined modality therapy, RT is often omitted in fear of late adverse effects; however, the application of modern RT could limit these toxic effects. OBJECTIVE To determine the radiation doses delivered to organs at risk with modern involved-site RT among patients with ESFHL treated with 20 Gy after 2 cycles of ABVD. DESIGN, SETTING, AND PARTICIPANTS This case series included 42 adult patients with ESFHL (according to the German Hodgkin Study Group criteria) who were treated between 2010 and 2019, achieved complete response by positron emission tomography-computed tomography (1-3 on 5-point scale) following 2 cycles of ABVD, and then received consolidative RT. The study was conducted at a single comprehensive cancer center. EXPOSURES 2 cycles of chemotherapy followed by 20-Gy involved-site RT. MAIN OUTCOMES AND MEASURES The medical records of patients with ESFHL were examined. Organs at risk were contoured, and doses were calculated. Progression-free survival, defined from date of diagnosis to disease progression, relapse, or death, and overall survival were estimated using the Kaplan-Meier method. RESULTS The cohort comprised 42 patients with ESFHL (median [range] age at diagnosis, 35 [18-74] years; 18 [43%] women; 24 [57%] with stage II disease). At a median follow-up of 44.6 (95% CI, 27.6-61.6) months, the 3-year progression-free survival and overall survival rates were 91.2% (95% CI, 74.9%-97.1%) and 97.0% (95% CI, 80.4%-99.6%), respectively. The mean heart dose was less than 5 Gy (mean, 0.8 Gy; SD, 1.5 Gy; range, 0-4.8 Gy) in all patients. The mean (SD) breast dose for both breasts was 0.1 (0.2) Gy (left breast range, 0-1.0 Gy; right breast range, 0-0.9 Gy). CONCLUSIONS AND RELEVANCE In this study, combined modality therapy with 2 cycles of ABVD and 20 Gy for ESFHL was highly effective and avoided excess doses to organs at risk, which may limit long-term toxic effects.
Collapse
Affiliation(s)
- Chelsea C. Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jillian R. Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Penny Fang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mikaela E Bankston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sarah A. Milgrom
- Department of Radiation Oncology, University of Colorado, Denver
| | - David Boyce
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Hun Ju Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Ranjit Nair
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Raphael Steiner
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Paolo Strati
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Sairah Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Swaminathan P. Iyer
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Jason Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Simrit Parmar
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - M. Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Sattva Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Christopher Flowers
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Bouthaina S. Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
45
|
Rechner LA, Modiri A, Stick LB, Maraldo MV, Aznar MC, Rice SR, Sawant A, Bentzen SM, Vogelius IR, Specht L. Biological optimization for mediastinal lymphoma radiotherapy - a preliminary study. Acta Oncol 2020; 59:879-887. [PMID: 32216586 PMCID: PMC7446040 DOI: 10.1080/0284186x.2020.1733654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
Purpose: In current radiotherapy (RT) planning and delivery, population-based dose-volume constraints are used to limit the risk of toxicity from incidental irradiation of organs at risks (OARs). However, weighing tradeoffs between target coverage and doses to OARs (or prioritizing different OARs) in a quantitative way for each patient is challenging. We introduce a novel RT planning approach for patients with mediastinal Hodgkin lymphoma (HL) that aims to maximize overall outcome for each patient by optimizing on tumor control and mortality from late effects simultaneously.Material and Methods: We retrospectively analyzed 34 HL patients treated with conformal RT (3DCRT). We used published data to model recurrence and radiation-induced mortality from coronary heart disease and secondary lung and breast cancers. Patient-specific doses to the heart, lung, breast, and target were incorporated in the models as well as age, sex, and cardiac risk factors (CRFs). A preliminary plan of candidate beams was created for each patient in a commercial treatment planning system. From these candidate beams, outcome-optimized (O-OPT) plans for each patient were created with an in-house optimization code that minimized the individual risk of recurrence and mortality from late effects. O-OPT plans were compared to VMAT plans and clinical 3DCRT plans.Results: O-OPT plans generally had the lowest risk, followed by the clinical 3DCRT plans, then the VMAT plans with the highest risk with median (maximum) total risk values of 4.9 (11.1), 5.1 (17.7), and 7.6 (20.3)%, respectively (no CRFs). Compared to clinical 3DCRT plans, O-OPT planning reduced the total risk by at least 1% for 9/34 cases assuming no CRFs and 11/34 cases assuming presence of CRFs.Conclusions: We developed an individualized, outcome-optimized planning technique for HL. Some of the resulting plans were substantially different from clinical plans. The results varied depending on how risk models were defined or prioritized.
Collapse
Affiliation(s)
- Laura Ann Rechner
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Arezoo Modiri
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Line Bjerregaard Stick
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Maja V. Maraldo
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marianne C. Aznar
- Manchester Cancer Research Centre, Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Søren M. Bentzen
- Greenebaum Comprehensive Cancer Center, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ivan Richter Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
46
|
Kirova Y. [Practical guidelines for the radiotherapy for patients presented with haematological malignancies in the epidemic COVID-19 situation: International Lymphoma Radiation Oncology Group recommendations]. Cancer Radiother 2020; 24:194-195. [PMID: 32402596 PMCID: PMC7198151 DOI: 10.1016/j.canrad.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Y Kirova
- Département de radiothérapie-oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France.
| |
Collapse
|
47
|
Šalaševičius L, Vaitkevičienė GE, Pasaulienė R, Kiudelienė R, Ivanauskaitė-Didžiokienė E, Vajauskas D, Jurkienė N, Rascon J. Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab. Medicina (Kaunas) 2020; 56:medicina56040155. [PMID: 32244416 PMCID: PMC7230437 DOI: 10.3390/medicina56040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
Radiation-induced sarcoma (RIS) has been reported as a late secondary malignancy following radiotherapy for various types of cancer with a median latency of 10 years. We describe an early RIS that developed in an adolescent within three years of treatment (including PD-L1 check-point inhibitor Nivolumab) of a relapsed classic Hodgkin lymphoma (HL) and was diagnosed post-mortem. The patient died of the progressive RIS that was misleadingly assumed to be a resistant HL based on the positive PET/CT scan. Repetitive tumor biopsies are warranted in cases of aggressive and multi-drug resistant HL to validate imaging findings, ensure correct diagnosis and avoid overtreatment.
Collapse
Affiliation(s)
- Lukas Šalaševičius
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
| | - Goda Elizabeta Vaitkevičienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
| | - Ramunė Pasaulienė
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
| | - Rosita Kiudelienė
- Center of Pediatric Oncology and Hematology at Pediatric Department and Hospital of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | | | - Donatas Vajauskas
- Institute of Biomedical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University, 03101 Vilnius, Lithuanian;
- Radiology and Nuclear Medicine Center, Department of Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Nemira Jurkienė
- Radiology Clinic, Nuclear Medicine Department of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Jelena Rascon
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
- Correspondence:
| |
Collapse
|
48
|
Elborai Y, Elgammal A, Salama A, Fawzy M, El-Desouky ED, Attia I, Shalaby LM. Cyclooxygenase-2 expression as a prognostic factor in pediatric classical Hodgkin lymphoma. Clin Transl Oncol 2020; 22:1539-1547. [PMID: 31970686 DOI: 10.1007/s12094-020-02297-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/09/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Cyclooxygenase-2 (COX-2) is an inflammation-related enzyme that has been shown to have a role in tumor initiation, angiogenesis, and proliferation. It has been demonstrated that COX-2 expression is increased in many tumors and is a negative prognostic parameter. Our objective is to investigate the prognostic value of COX-2 expression in pediatric patients with classical Hodgkin lymphoma (CHL). METHODS This was a retrospective analysis in pediatric patients (n = 127) diagnosed with CHL and treated at the pediatric oncology department, National Cancer Institute, Cairo University, January 2005-June 2013. We correlated COX-2 immunostaining in Reed-Sternberg (RS) cells with clinical variables and outcome. RESULTS COX-2 was expressed on 38.6% of RS cells. The median follow-up time was 48.4 months (range 4-114 months). The 5-year OS and PFS, in COX-2(+ve) versus COX-2(-ve) was 85.3% versus 96.0% (p = 0.248) and 78.6% versus 84.3% (p = 0.354), respectively. A multivariate analysis showed that COX-2(+ve) was not significantly associated with the 5-year OS (HR = 2.9; 95% CI 0.7-12.4, p = 0.149) or with the 5-year PFS (HR = 1.4; 95% CI 0.6-3.2, p = 0.490). High-risk patients in the COX-2(+ve) group had a significantly lower 5-year OS (p = 0.021). The 5-year PFS was significantly lower in the COX-2(+ve) group with B symptoms (p = 0.023) and bulky disease (p = 0.028). Radiotherapy was given only to high-risk patients; survival was much better in radiation-treated children in both the Cox-2(+ve) and Cox-2(-ve) groups. The magnitude of the radiotherapy effect was also greater in the Cox-2(+ve) group, but this difference was not statistically significant. CONCLUSION COX-2 expression showed a tendency to be a poor prognostic factor, but it failed to provide meaningful independent information. Further larger studies are needed to investigate COX-2 as a prognostic factor and potential therapeutic target.
Collapse
Affiliation(s)
- Y Elborai
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt.
| | - A Elgammal
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
| | - A Salama
- Pathology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - M Fawzy
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
| | - E D El-Desouky
- Biostatistics and Cancer Epidemiology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - I Attia
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
| | - L M Shalaby
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
| |
Collapse
|
49
|
Furzer J, Tessier L, Hodgson D, Cotton C, Nathan PC, Gupta S, Pechlivanoglou P. Cost-Utility of Early Breast Cancer Surveillance in Survivors of Thoracic Radiation-Treated Adolescent Hodgkin Lymphoma. J Natl Cancer Inst 2020; 112:63-70. [PMID: 31070751 PMCID: PMC7825489 DOI: 10.1093/jnci/djz037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/24/2019] [Accepted: 03/22/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Adolescent women treated for Hodgkin lymphoma (HL) are at increased risk of breast cancer (BC). We evaluate the cost-utility of eight high-risk BC surveillance strategies for this population, including the Children's Oncology Group guideline of same-day annual mammography and magnetic resonance imaging (MRI) beginning at age 25 years. METHODS A discrete event simulation model was used to simulate the life histories of a cohort of 500 000 25-year-old women treated for HL at age 15 years. We estimated BC incidence and mortality, life expectancy, quality-adjusted life-years (QALYs), health-care costs, and the relative cost-utility (incremental cost-utility ratio [ICUR]) under the eight assessed surveillance strategies. One-way sensitivity analysis enabled modeling of uncertainty evaluation. A publicly funded health-care payer perspective was adopted. RESULTS Costs across the eight screening strategies ranged from $32 643 to $43 739, whereas QALYs ranged from 24.419 to 24.480. In an incremental cost-effectiveness analysis, annual mammography beginning at age 25 years was associated with an ICUR of $43 000/QALY gained, annual MRI beginning at age 25 years with a switch to annual mammography at age 50 years had an ICUR of $148 000/QALY, and annual MRI beginning at age 25 years had an ICUR of $227 222/QALY. Among all assessed surveillance strategies, the differences in life expectancy were small. CONCLUSIONS Current high-risk BC surveillance guidelines do not reflect the most cost-effective strategy in survivors of adolescent HL. The results suggest that groups at high risk of BC may require high-risk surveillance guidelines that reflect their specific risk profile.
Collapse
Affiliation(s)
- Jill Furzer
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Tessier
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul C Nathan
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
50
|
Novosad O, Skrypets T, Pastushenko I, Kadnikova T, Gorbach O, Kozlov V, Mykhalska L, Kosinova V, Kostiukova N, Karnabeda O, Stratienko V, Novikov M, Oliinichenko O, Kmetyuk I, Karpova O, Ashykhmin A, Lukjanec O, Kriachok I. A Ukrainian multicenter prospective study of the value of PET/ CT prognostic role in primary patients with Hodgkins lymphoma in a real-life cohort. Klin Onkol 2020; 33:450-457. [PMID: 33685195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION In recent years, the positron emission tomography combined with computed tomography (PET/CT) has changed and the treatment approaches in Hodgkins lymphoma (HL) patients have entirely improved. The main idea in several studies is the use of PET/CT and the International Prognostic Score (IPS) protocols in identification of patients within a high-risk group and potential early relapse/refractory disease. MATERIALS AND METHODS This study was based on PET/CT evaluation and treatment strategies of patients from eight Centers of Hematology in Ukraine. The patients included were newly dia-gnosed with HL and were aged 67 years or younger. They received a treatment with ABVD or BEACOPP-14/esc or “switched-regimens” (ABVD + BEACOPP-esc/14, BEACOPP-esc/14 + ABVD). The primary endpoints were to assess a correlation between PET/CT findings at the time of dia-gnosis, response to the therapy and clinical outcome (relapse/death) for patients with early and advanced stages of HL. The secondary endpoints were to evaluate the relationship between IPS and PET/CT findings. RESULTS The study group included 106 patients. The overall response rate (ORR) was 90.5%. The ORR for patients with stages I-II was 96.5% (55/57) vs. 91% (41/45) for stage III-IV patients. In total, the disease progression occurred in 58.3% (7/12) of PET2+ patients and in 13.3% (12/90) of PET2 patients (P < 0.05). No significant difference was found between the event free survival (EFS) rate and IPS for patients with PET2+ vs. PET2, (log-rank test; P = 0.4). The PET3 status was found in 88.8% (79/89) of the study group patients and 1.2% (10/89) had a PET3+ status (P < 0.05). Using the Cox regression, we confirmed a significant correlation between EFS with PET3 Deauville scale (DS) and IPS. Patients with DS 1-2, DS 3 and DS 4-5 had a 1-year event-free survival of 94.4%, 100% and 33%, respectively (HR 0.56; 95% CI 1.07-2.8; P < 0.02). Our multivariable analysis showed no statistically significant correlation between PET2+ and PET3+ status and extranodal involvement or large tumor burden. CONCLUSION The results of using PET/CT in patients with primary HL demonstrated a high prognostic value of PET at the end of the treatment. In addition, we confirmed the predictive role of IPS prognostic model in the treatment outcome depending on PET status.
Collapse
|