Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Children's Oncology Group, Monrovia, California.
Int J Radiat Oncol Biol Phys. 2018 Apr 1;100(5):1119-1125. doi: 10.1016/j.ijrobp.2018.01.002. Epub 2018 Jan 6.
The presented protocol for pediatric intermediate-risk Hodgkin lymphoma evaluated the use of a dose-intensive chemotherapy regimen (ABVE-PC [doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, prednisone]) with response-based therapy augmentation (addition of DECA [dexamethasone, etoposide, cisplatin, cytarabine]) or therapy reduction (elimination of radiation).
A central review of the radiation therapy data for quality assurance was performed, and the association between radiation protocol deviation (RPD) and relapse was assessed in the pediatric group (age <15 years) and adolescent and young adult (AYA) group (age ≥15-21 years). Involved-field radiation therapy (IFRT) planning was reviewed before the start of treatment and at treatment completion. The records were reviewed through the Quality Assurance Review Center's central review to identify RPD, classified according to dose deviation (DD), volume deviation (VD), undertreatment (UT), and overtreatment (OT). DDs and VDs were further classified as major or minor.
Of the 1712 patients enrolled, 1155 received IFRT, of whom, 216 (18.7%) had RPDs. The DD and VD patterns were similar between the pediatric and AYA groups. Minor VDs were most common. UT RPDs accounted for 69% in the pediatric group and 75% in the AYA group. Of the 35 patients with relapse and a RPD, 29 had an undertreatment RPD. Among the patients who received IFRT, a significant difference was found in the cumulative incidence rates of relapse between the pediatric and AYA groups (P = .03); however, no significant difference was found between patients with and without RPD (P = .2).
Most RPDs were minor and consisted of UT in the AYA and pediatric populations both. No difference was observed in RPDs between the pediatric and AYA patients. Thus, in a well-defined and standardized protocol, the RPD distributions for AYA patients will be similar to those for pediatric population. However, the increased cumulative incidence of relapse in the AYA patients who had received IFRT compared with the pediatric population requires further exploration, given the potential differences in clinical outcomes in the AYA population.
本研究针对儿科中危霍奇金淋巴瘤患者，评估了采用剂量密集化疗方案（ABVE-PC [多柔比星、博来霉素、长春新碱、依托泊苷、环磷酰胺、泼尼松]）并基于反应进行治疗强化（加入 DECA [地塞米松、依托泊苷、顺铂、阿糖胞苷]）或治疗减化（取消放疗）的效果。
我们对放疗数据进行了中心审查，以确保质量保证，并在儿科组（年龄＜15 岁）和青少年及年轻成人（AYA）组（年龄≥15-21 岁）中评估了放疗方案偏离（RPD）与复发之间的关联。在治疗开始前和治疗完成时，我们对累及野放疗（IFRT）计划进行了审查。通过质量保证审查中心的中心审查，我们查阅了记录，以确定 RPD，并根据剂量偏离（DD）、体积偏离（VD）、治疗不足（UT）和治疗过度（OT）进行分类。DD 和 VD 进一步分为主要和次要偏离。
在入组的 1712 名患者中，有 1155 名患者接受了 IFRT，其中 216 名（18.7%）出现了 RPD。儿科组和 AYA 组的 DD 和 VD 模式相似。最常见的是轻微的 VD。儿科组有 69%的 UT RPD，AYA 组有 75%。在 35 名有 RPD 且发生复发的患者中，有 29 名是治疗不足 RPD。在接受 IFRT 的患者中，儿科组和 AYA 组之间的复发累积发生率存在显著差异（P=0.03）；然而，在有和没有 RPD 的患者之间没有差异（P=0.2）。
在 AYA 和儿科人群中，大多数 RPD 是轻微的 UT。儿科和 AYA 患者之间的 RPD 没有差异。因此，在明确且标准化的方案中，AYA 患者的 RPD 分布将与儿科人群相似。然而，在接受 IFRT 的 AYA 患者中，复发的累积发生率增加，需要进一步探索，因为 AYA 人群的临床结局可能存在差异。
