Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
Department of Pediatric Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Int J Radiat Oncol Biol Phys. 2023 Oct 1;117(2):400-403. doi: 10.1016/j.ijrobp.2023.04.022. Epub 2023 Apr 26.
: Clear indications do not exist for consolidative radiotherapy (CRT) in relapsed and refractory pediatric Hodgkin lymphoma (rrpHL). Increasing numbers of rrpHL patients are radiation naïve, as response-adapted front-line therapies omit CRT for favorable responses. We evaluated practice patterns among treating oncologists for rrpHL.
: A survey developed by pediatric and radiation oncologists was distributed to Children’s Oncology Group (COG) Hodgkin Lymphoma Committee members during the Fall 2021 COG meeting. Questions ascertained respondent specialty and annual rrpHL patient volumes. Respondents provided treatment recommendations for two cases. Case 1: 21-year-old female with stage IIB bulky mediastinal HL treated with ABVDx6 without initial radiotherapy with neck and mediastinal relapse and Deauville 4 (D4) response after 2 second-line chemotherapies. Case 1 was modified (modCase1) to a D2 response after second-line therapy. Case 2: 21-year-old female with non-bulky stage IIB disease treated with ABVDx6 without initial radiotherapy with splenic, mediastinal, and neck relapse and D4 activity in those sites after 2 second-line therapies. Descriptive statistics are presented.
: 20 (83%) pediatric hematologist/oncologists and 4 (17%) radiation oncologists completed the survey. After autologous stem cell transplant (ASCT) for Case 1, 58% recommended CRT followed by brentuximab vedotin (Bv) maintenance and 33% recommended involved-site radiotherapy (ISRT) alone. For modCase1, 63% would consider CRT instead of ASCT. With ASCT, 21% would recommend CRT to bulk and 38% to all sites at initial relapse. After ASCT for Case 2, 75% recommended ISRT followed by Bv and 17% ISRT alone.
: In a sample of predominantly pediatric-oncologist COG members, most respondents considered that CRT has a role for patients with radiation-naive rrpHL both for groups with D4 disease as well as D2 disease pre-ASCT.
复发和难治性儿童霍奇金淋巴瘤（rrpHL）中并不存在巩固性放疗（CRT）的明确适应证。越来越多的 rrpHL 患者是初次接受放疗，因为适应性一线治疗方案对有利反应省略了 CRT。我们评估了治疗 rrpHL 的肿瘤学家的实践模式。
由儿科和放疗肿瘤学家制定的调查问卷在 2021 年秋季 COG 会议期间分发给儿童肿瘤学组（COG）霍奇金淋巴瘤委员会成员。问题确定了受访者的专业和每年 rrpHL 患者的数量。受访者对两个病例提供了治疗建议。病例 1：21 岁女性，IIB 期纵隔巨大肿块霍奇金淋巴瘤，ABVDx6 治疗 6 个周期，无初始放疗，颈部和纵隔复发，二线化疗后 Deauville 4（D4）反应。病例 1 经二线治疗后修改为 D2 反应（modCase1）。病例 2：21 岁女性，IIB 期非肿块性疾病，ABVDx6 治疗 6 个周期，无初始放疗，二线治疗后脾、纵隔和颈部复发，这些部位的 D4 活性。呈现描述性统计数据。
20 名（83%）儿科血液科/肿瘤学家和 4 名（17%）放疗肿瘤学家完成了调查。在自体干细胞移植（ASCT）治疗病例 1 后，58%的人建议 CRT 后加用 Brentuximab Vedotin（Bv）维持治疗，33%的人建议单独使用累及部位放疗（ISRT）。对于 modCase1，63%的人会考虑 CRT 而不是 ASCT。在 ASCT 后，21%的人建议对肿块进行 CRT，38%的人建议对初始复发的所有部位进行 CRT。在 ASCT 治疗病例 2 后，75%的人建议 ISRT 后加用 Bv，17%的人建议单独使用 ISRT。
在 COG 成员中，大多数是儿科肿瘤学家的样本中，大多数受访者认为 CRT 对初治 rrpHL 患者具有作用，无论是 D4 疾病还是 ASCT 前的 D2 疾病。
