Predictive Factor Analysis of Response-Adapted Radiation Therapy for Chemotherapy-Sensitive Pediatric Hodgkin Lymphoma: Analysis of the Children's Oncology Group AHOD 0031 Trial
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montreal, Québec (Canada)
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee (United States)
- Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
- Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario (Canada)
- Division of Hematology and Oncology, Women & Children's Hospital of Buffalo, Buffalo, New York (United States)
- Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States)
Purpose: To evaluate whether clinical risk factors could further distinguish children with intermediate-risk Hodgkin lymphoma (HL) with rapid early and complete anatomic response (RER/CR) who benefit significantly from involved-field RT (IFRT) from those who do not, and thereby aid refinement of treatment selection. Methods and Materials: Children with intermediate-risk HL treated on the Children's Oncology Group AHOD 0031 trial who achieved RER/CR with 4 cycles of chemotherapy, and who were randomized to 21-Gy IFRT or no additional therapy (n=716) were the subject of this study. Recursive partitioning analysis was used to identify factors associated with clinically and statistically significant improvement in event-free survival (EFS) after randomization to IFRT. Bootstrap sampling was used to evaluate the robustness of the findings. Result: Although most RER/CR patients did not benefit significantly from IFRT, those with a combination of anemia and bulky limited-stage disease (n=190) had significantly better 4-year EFS with the addition of IFRT (89.3% vs 77.9% without IFRT; P=.019); this benefit was consistently reproduced in bootstrap analyses and after adjusting for other prognostic factors. Conclusion: Although most patients achieving RER/CR had favorable outcomes with 4 cycles of chemotherapy alone, those children with initial bulky stage I/II disease and anemia had significantly better EFS with the addition of IFRT as part of combined-modality therapy. Further work evaluating the interaction of clinical and biologic factors and imaging response is needed to further optimize and refine treatment selection.
- OSTI ID:
- 22645715
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 96, Issue 5; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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