Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
Department of Radiation Oncology, University of Colorado, Denver.
JAMA Netw Open. 2020 Sep 1;3(9):e2013935. doi: 10.1001/jamanetworkopen.2020.13935.
Response-adapted randomized trials have used positron emission tomography-computed tomography to attempt to identify patients with early-stage favorable Hodgkin lymphoma (ESFHL) who could be treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) without radiation therapy (RT). While maximal efficacy is demonstrated with combined modality therapy, RT is often omitted in fear of late adverse effects; however, the application of modern RT could limit these toxic effects.
To determine the radiation doses delivered to organs at risk with modern involved-site RT among patients with ESFHL treated with 20 Gy after 2 cycles of ABVD.
DESIGN, SETTING, AND PARTICIPANTS: This case series included 42 adult patients with ESFHL (according to the German Hodgkin Study Group criteria) who were treated between 2010 and 2019, achieved complete response by positron emission tomography-computed tomography (1-3 on 5-point scale) following 2 cycles of ABVD, and then received consolidative RT. The study was conducted at a single comprehensive cancer center.
2 cycles of chemotherapy followed by 20-Gy involved-site RT.
The medical records of patients with ESFHL were examined. Organs at risk were contoured, and doses were calculated. Progression-free survival, defined from date of diagnosis to disease progression, relapse, or death, and overall survival were estimated using the Kaplan-Meier method.
The cohort comprised 42 patients with ESFHL (median [range] age at diagnosis, 35 [18-74] years; 18 [43%] women; 24 [57%] with stage II disease). At a median follow-up of 44.6 (95% CI, 27.6-61.6) months, the 3-year progression-free survival and overall survival rates were 91.2% (95% CI, 74.9%-97.1%) and 97.0% (95% CI, 80.4%-99.6%), respectively. The mean heart dose was less than 5 Gy (mean, 0.8 Gy; SD, 1.5 Gy; range, 0-4.8 Gy) in all patients. The mean (SD) breast dose for both breasts was 0.1 (0.2) Gy (left breast range, 0-1.0 Gy; right breast range, 0-0.9 Gy).
In this study, combined modality therapy with 2 cycles of ABVD and 20 Gy for ESFHL was highly effective and avoided excess doses to organs at risk, which may limit long-term toxic effects.
适应反应的随机试验已经使用正电子发射断层扫描-计算机断层扫描来试图确定早期阶段有利霍奇金淋巴瘤（ESFHL）患者，他们可以用多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD）治疗，而无需放射治疗（RT）。虽然联合治疗显示出最大的疗效，但由于担心晚期不良反应，通常会省略 RT；然而，现代 RT 的应用可以限制这些毒性作用。
确定在接受 ABVD 两个周期后接受 20Gy 局部区域 RT 的 ESFHL 患者的风险器官所接受的放射剂量。
设计、地点和参与者：本病例系列纳入 42 名符合德国霍奇金研究组标准的 ESFHL 成年患者（n=42），他们于 2010 年至 2019 年期间接受治疗，在接受 ABVD 两个周期后通过正电子发射断层扫描-计算机断层扫描（5 分制的 1-3 分）达到完全缓解，然后接受巩固性 RT。研究在一家综合性癌症中心进行。
两个周期的化疗后进行 20Gy 局部区域 RT。
检查 ESFHL 患者的病历。勾画风险器官，计算剂量。无进展生存期定义为从诊断日期到疾病进展、复发或死亡，使用 Kaplan-Meier 方法估计总生存期。
该队列包括 42 名 ESFHL 患者（中位[范围]诊断时年龄，35[18-74]岁；18[43%]女性；24[57%]为 II 期疾病）。中位随访 44.6（95%CI，27.6-61.6）个月后，3 年无进展生存率和总生存率分别为 91.2%（95%CI，74.9%-97.1%）和 97.0%（95%CI，80.4%-99.6%）。所有患者的心脏平均剂量均小于 5Gy（平均 0.8Gy；SD，1.5Gy；范围，0-4.8Gy）。双侧乳房的平均（SD）乳房剂量为 0.1（0.2）Gy（左乳范围，0-1.0Gy；右乳范围，0-0.9Gy）。
在这项研究中，ABVD 两个周期联合 20Gy 治疗 ESFHL 非常有效，避免了风险器官的过量剂量，这可能限制了长期毒性作用。
