Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA.
Department of Radiation Oncology, Geisinger Medical Center, Danville, PA, USA.
Leuk Lymphoma. 2020 Jul;61(7):1610-1617. doi: 10.1080/10428194.2020.1725506. Epub 2020 Feb 12.
Despite a number of randomized trials, there is clinical equipoise whether de-escalation with the omission of radiotherapy (RT) in positron emission tomography (PET) responders is safe in early-stage Hodgkin lymphoma (HL). A comprehensive Medline and conference abstracts search was performed to identify prospective studies with the following criteria: early-stage (stage I/II) HL treated with anthracycline-based chemotherapy with PET-directed randomization to ± consolidation RT. Four studies were meta-analyzed with a total of 2267 patients (RT: = 1136, no RT: = 1131). Pooled analysis showed a significant progression-free survival (PFS) benefit with RT (HR = 2.08, 95% CI 1.27- 3.43 = .004, RE). There was no statistically significant overall survival (OS) benefit with RT for all patients (HR = 0.92, 95% CI 0.37-2.30, = 0.85), nor in favorable (HR = 0.90, = .89) or unfavorable risk (HR = 1.01, = .99). In early-stage PET-negative HL, consolidative RT consistently improves PFS across risk stratifications over PET-directed omission of RT, with no significant impact on OS.
尽管进行了多项随机试验，但在 PET 反应者中省略放疗（RT）的降级治疗在早期霍奇金淋巴瘤（HL）中是否安全仍存在临床争议。进行了全面的 Medline 和会议摘要搜索，以确定符合以下标准的前瞻性研究：采用含蒽环类药物的化疗治疗早期（I/II 期）HL，并通过 PET 指导随机化来决定是否进行巩固 RT。对四项研究进行了荟萃分析，共有 2267 名患者（RT：= 1136，无 RT：= 1131）。汇总分析显示，RT 治疗具有显著的无进展生存（PFS）获益（HR=2.08，95%CI 1.27-3.43，=0.004，RE）。对于所有患者，RT 并没有显著的总生存（OS）获益（HR=0.92，95%CI 0.37-2.30，=0.85），无论是在预后良好（HR=0.90，=0.89）还是预后不良（HR=1.01，=0.99）的风险分层中均如此。在早期 PET 阴性 HL 中，与 RT 指导的省略相比，巩固 RT 可在各个风险分层中一致改善 PFS，而对 OS 没有显著影响。
