Kriz Jan, Reinartz Gabriele, Dietlein Markus, Kobe Carsten, Kuhnert Georg, Haverkamp Heinz, Haverkamp Uwe, Engenhart-Cabillic Rita, Herfarth Klaus, Lukas Peter, Schmidberger Heinz, Staar Susanne, Hegerfeld Kira, Baues Christian, Engert Andreas, Eich Hans Theodor
Department of Radiation Oncology, University of Münster, Münster, Germany.
Department of Nuclear Medicine, University of Cologne, Cologne, Germany.
Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):46-53. doi: 10.1016/j.ijrobp.2015.01.048.
To determine, in the setting of advanced-stage of Hodgkin lymphoma (HL), whether relapses occur in the irradiated planning target volume and whether the definition of local radiation therapy (RT) used by the German Hodgkin Study Group (GHSG) is adequate, because there is no harmonization of field and volume definitions among the large cooperative groups in the treatment of advanced-stage HL.
All patients with residual disease of ≥ 2.5 cm after multiagent chemotherapy (CTX) were evaluated using additional positron emission tomography (PET), and those with a PET-positive result were irradiated with 30 Gy to the site of residual disease. We re-evaluated all sites of disease before and after CTX, as well as the PET-positive residual tumor that was treated in all relapsed patients. Documentation of radiation therapy (RT), treatment planning procedures, and portal images were carefully analyzed and compared with the centrally recommended RT prescription. The irradiated sites were compared with sites of relapse using follow-up computed tomography scans.
A total of 2126 patients were enrolled, and 225 patients (11%) received RT. Radiation therapy documents of 152 irradiated patients (68%) were analyzed, with 28 irradiated patients (11%) relapsing subsequently. Eleven patients (39%) had an in-field relapse, 7 patients (25%) relapsed outside the irradiated volume, and an additional 10 patients (36%) showed mixed in- and out-field relapses. Of 123 patients, 20 (16%) with adequately performed RT relapsed, compared with 7 of 29 patients (24%) with inadequate RT.
The frequency and pattern of relapses suggest that local RT to PET-positive residual disease is sufficient for patients in advanced-stage HL. Insufficient safety margins of local RT may contribute to in-field relapses.
在晚期霍奇金淋巴瘤（HL）的背景下，确定复发是否发生在照射的计划靶区内，以及德国霍奇金淋巴瘤研究组（GHSG）所采用的局部放射治疗（RT）定义是否恰当，因为在晚期HL的治疗中，各大协作组之间的照射野和体积定义尚未统一。
所有在多药化疗（CTX）后残留病灶≥2.5 cm的患者均接受额外的正电子发射断层扫描（PET）评估，PET结果呈阳性的患者对残留病灶部位给予30 Gy照射。我们重新评估了所有患者化疗前后的所有病灶部位，以及所有复发患者中接受治疗的PET阳性残留肿瘤。对照射治疗（RT）记录、治疗计划程序和射野图像进行了仔细分析，并与中央推荐的RT处方进行了比较。利用随访计算机断层扫描将照射部位与复发部位进行比较。
共纳入2126例患者，225例（11%）接受了RT。分析了152例接受照射患者（68%）的放射治疗记录，其中28例（11%）随后复发。11例（39%）为野内复发，7例（25%）在照射体积外复发，另外10例（36%）表现为野内和野外混合复发。在123例患者中，20例（16%）接受了充分RT的患者复发，而29例（24%）接受不充分RT的患者中有7例复发。
复发的频率和模式表明，对PET阳性残留病灶进行局部RT对晚期HL患者是足够的。局部RT安全边缘不足可能导致野内复发。
