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Title: Role of Salvage Radiation Therapy for Patients With Relapsed or Refractory Hodgkin Lymphoma Who Failed Autologous Stem Cell Transplant

Abstract

Purpose: To analyze, through chart review, the efficacy of salvage radiation therapy (sRT) for relapsed or progressive Hodgkin lymphoma (HL) patients who failed autologous stem cell transplant (ASCT). Patients and Methods: Among 347 patients with recurrent/refractory HL who received ASCT from 1986-2006, 163 had post-ASCT progression or relapse. Of these, 56 received sRT and form the basis of this report. Median age at sRT was 30 years (range, 17-59 years). Disease was confined to lymph nodes in 27 patients, whereas 24 had both nodal and extranodal disease. Salvage radiation therapy alone was given in 34 patients (61%), and sRT plus chemotherapy was given in 22 (39%). Median interval from ASCT to sRT was 0.8 years (range, 0.1-5.6 years). The median dose was 35 Gy (range, 8-40.3 Gy). The sRT technique was extended-field in 14 patients (25%) and involved-field in 42 (75%). Results: The median follow-up from sRT was 31.3 months (range, 0.2-205.5 months). Overall response rate was 84% (complete response: 36%; partial response: 48%). The median overall survival was 40.8 months (95% confidence interval, 34.2-56.3 months). The 5-year overall survival was 29% (95% confidence interval, 14%-44%). The 2-year progression-free survival (PFS) was 16%; the 2-year local PFS was 65%, whereasmore » the 2-year systemic PFS was 17%. The 1-year PFS was higher in patients in whom all diseased sites were irradiated (49%) compared with those in whom only the symptomatic site was treated (22%, P=.07). Among 20 alive patients, 5 were disease free (at 6.4, 6.8, 7.4, 7.9, and 17.1 years). Conclusion: For patients with HL who fail ASCT, a selective use of RT provides a durable local control rate of 65% at 2 years and should be considered as part of the standard management plan for the palliation of incurable HL. Occasionally irradiation of truly localized disease can lead to long-term survival.« less

Authors:
 [1];  [2];  [3]; ; ; ;  [1]; ;  [3];  [1]
  1. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada)
  2. Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada)
  3. Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada)
Publication Date:
OSTI Identifier:
22149587
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; GY RANGE 01-10; GY RANGE 10-100; IRRADIATION; LYMPH NODES; LYMPHOMAS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; STANDARDS; STEM CELLS; TRANSPLANTS

Citation Formats

Goda, Jayant S., Massey, Christine, Kuruvilla, John, Gospodarowicz, Mary K., Wells, Woodrow, Hodgson, David C., Sun, Alexander, Keating, Armand, Crump, Michael, and Tsang, Richard W., E-mail: richard.tsang@rmp.uhn.on.ca. Role of Salvage Radiation Therapy for Patients With Relapsed or Refractory Hodgkin Lymphoma Who Failed Autologous Stem Cell Transplant. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.04.007.
Goda, Jayant S., Massey, Christine, Kuruvilla, John, Gospodarowicz, Mary K., Wells, Woodrow, Hodgson, David C., Sun, Alexander, Keating, Armand, Crump, Michael, & Tsang, Richard W., E-mail: richard.tsang@rmp.uhn.on.ca. Role of Salvage Radiation Therapy for Patients With Relapsed or Refractory Hodgkin Lymphoma Who Failed Autologous Stem Cell Transplant. United States. doi:10.1016/J.IJROBP.2012.04.007.
Goda, Jayant S., Massey, Christine, Kuruvilla, John, Gospodarowicz, Mary K., Wells, Woodrow, Hodgson, David C., Sun, Alexander, Keating, Armand, Crump, Michael, and Tsang, Richard W., E-mail: richard.tsang@rmp.uhn.on.ca. Thu . "Role of Salvage Radiation Therapy for Patients With Relapsed or Refractory Hodgkin Lymphoma Who Failed Autologous Stem Cell Transplant". United States. doi:10.1016/J.IJROBP.2012.04.007.
@article{osti_22149587,
title = {Role of Salvage Radiation Therapy for Patients With Relapsed or Refractory Hodgkin Lymphoma Who Failed Autologous Stem Cell Transplant},
author = {Goda, Jayant S. and Massey, Christine and Kuruvilla, John and Gospodarowicz, Mary K. and Wells, Woodrow and Hodgson, David C. and Sun, Alexander and Keating, Armand and Crump, Michael and Tsang, Richard W., E-mail: richard.tsang@rmp.uhn.on.ca},
abstractNote = {Purpose: To analyze, through chart review, the efficacy of salvage radiation therapy (sRT) for relapsed or progressive Hodgkin lymphoma (HL) patients who failed autologous stem cell transplant (ASCT). Patients and Methods: Among 347 patients with recurrent/refractory HL who received ASCT from 1986-2006, 163 had post-ASCT progression or relapse. Of these, 56 received sRT and form the basis of this report. Median age at sRT was 30 years (range, 17-59 years). Disease was confined to lymph nodes in 27 patients, whereas 24 had both nodal and extranodal disease. Salvage radiation therapy alone was given in 34 patients (61%), and sRT plus chemotherapy was given in 22 (39%). Median interval from ASCT to sRT was 0.8 years (range, 0.1-5.6 years). The median dose was 35 Gy (range, 8-40.3 Gy). The sRT technique was extended-field in 14 patients (25%) and involved-field in 42 (75%). Results: The median follow-up from sRT was 31.3 months (range, 0.2-205.5 months). Overall response rate was 84% (complete response: 36%; partial response: 48%). The median overall survival was 40.8 months (95% confidence interval, 34.2-56.3 months). The 5-year overall survival was 29% (95% confidence interval, 14%-44%). The 2-year progression-free survival (PFS) was 16%; the 2-year local PFS was 65%, whereas the 2-year systemic PFS was 17%. The 1-year PFS was higher in patients in whom all diseased sites were irradiated (49%) compared with those in whom only the symptomatic site was treated (22%, P=.07). Among 20 alive patients, 5 were disease free (at 6.4, 6.8, 7.4, 7.9, and 17.1 years). Conclusion: For patients with HL who fail ASCT, a selective use of RT provides a durable local control rate of 65% at 2 years and should be considered as part of the standard management plan for the palliation of incurable HL. Occasionally irradiation of truly localized disease can lead to long-term survival.},
doi = {10.1016/J.IJROBP.2012.04.007},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}