Research and Clinical Innovation Department, A. Lacassagne Cancer Center, Nice, France.
Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
J Clin Oncol. 2020 Nov 20;38(33):3905-3913. doi: 10.1200/JCO.20.00935. Epub 2020 Sep 18.
To investigate the role of consolidation radiotherapy (cRT) in advanced-stage Hodgkin lymphoma (HL) presenting at baseline with a large nodal mass (LNM) in complete metabolic response after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy.
Advanced-stage (IIB-IVB) HL patients, enrolled in the HD 0607 trial (Clinicaltrial.gov identifier NCT00795613), with both a negative PET after two (PET-2) and six (PET-6) ABVD cycles, who presented at baseline with an LNM, defined as a nodal mass with the largest diameter ≥ 5 cm, were prospectively randomly assigned to receive cRT over the LNM or no further treatment (NFT).
Among 296 randomly assigned patients, the largest diameter of LNM at baseline was 5-7 cm in 101 (34%; subgroup A) and 8-10 cm in 96 (32%; subgroup B), whereas classic bulky (diameter > 10 cm) was detected in 99 (33%; subgroup C). Two hundred eighty patients (88%) showed a postchemotherapy RM. The median dose of cRT was 30.6 Gy (range, 24-36 Gy). After a median follow-up of 5.9 years (range, 0.5-10 years), the 6-year progression-free survival rate of patients who underwent cRT or NFT was, respectively, 91% (95% CI, 84% to 99%) and 95% (95% CI, 89% to 100%; = .62) in subgroup A; 98% (95% CI, 93% to 100%) and 90% (95% CI, 80% to 100%; = .24) in subgroup B; 89% (95% CI, 81% to 98%) and 86% (95% CI, 77% to 96%; = .53) in subgroup C (classic bulky).
cRT could be safely omitted in patients with HL presenting with an LNM and a negative PET-2 and PET-6 scan, irrespective from the LNM size detected at baseline.
研究巩固性放疗（cRT）在阿霉素、博来霉素、长春碱和达卡巴嗪（ABVD）化疗后完全代谢缓解时基线期存在大淋巴结肿块（LNM）的晚期霍奇金淋巴瘤（HL）患者中的作用。
在 HD0607 试验（Clinicaltrial.gov 标识符 NCT00795613）中，纳入基线期 LNM（定义为最大直径≥5cm 的淋巴结肿块）且在 ABVD 化疗的第 2 个周期（PET-2）和第 6 个周期（PET-6）后 PET 均为阴性的晚期（IIB-IVB）HL 患者，前瞻性随机分配至接受 LNM 区域 cRT 或不进行进一步治疗（NFT）。
在 296 例随机分配的患者中，基线期 LNM 的最大直径为 5-7cm 的患者 101 例（34%；亚组 A），8-10cm 的患者 96 例（32%；亚组 B），而经典大肿块（直径>10cm）患者 99 例（33%；亚组 C）。280 例（88%）患者显示出化疗后完全缓解（RM）。cRT 的中位剂量为 30.6Gy（范围，24-36Gy）。在中位随访 5.9 年（范围，0.5-10 年）后，接受 cRT 或 NFT 的患者的 6 年无进展生存率分别为 91%（95%CI，84%至 99%）和 95%（95%CI，89%至 100%； =.62）在亚组 A；98%（95%CI，93%至 100%）和 90%（95%CI，80%至 100%； =.24）在亚组 B；89%（95%CI，81%至 98%）和 86%（95%CI，77%至 96%； =.53）在亚组 C（经典大肿块）。
在阿霉素、博来霉素、长春碱和达卡巴嗪化疗后完全代谢缓解且基线期存在 LNM 的 HL 患者中，无论基线期 LNM 大小如何，均可安全地省略巩固性放疗。
