Consolidation Radiotherapy Could Be Safely Omitted in Advanced Hodgkin Lymphoma With Large Nodal Mass in Complete Metabolic Response After ABVD: Final Analysis of the Randomized GITIL/FIL HD0607 Trial

Author:

Gallamini Andrea1,Rossi Andrea2,Patti Caterina3,Picardi Marco4,Romano Alessandra5,Cantonetti Maria6,Oppi Sara7,Viviani Simonetta8,Bolis Silvia9,Trentin Livio10,Gini Guido11,Battistini Roberta12,Chauvie Stephane13,Sorasio Roberto14,Pavoni Chiara2,Zanotti Roberta15,Cimminiello Michele16,Schiavotto Corrado17,Viero Piera18,Mulé Antonino3,Fallanca Federico19,Ficola Umberto20,Tarella Corrado2122,Guerra Luca23,Rambaldi Alessandro224

Affiliation:

1. Research and Clinical Innovation Department, A. Lacassagne Cancer Center, Nice, France

2. Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy

3. Hematology, V. Cervello Hospital, Palermo, Italy

4. Hematology, Policlinico Federico II Hospital, Naples, Italy

5. Hematology, Policlinico Vittorio Emanuele Hospital, Catania, Italy

6. Hematology, Policlinico Universitario Tor Vergata, Rome, Italy

7. Department of Hematology, Businco Hospital, Cagliari, Italy

8. Department of Hematology, IRCCS National Institute of Tumors, Milan, Italy

9. Hematology, San Gerardo Hospital, Monza, Italy

10. Hematology, Medicine, Padua University, Padua, Italy

11. Hematology, Ospedali Riuniti Le Torrette, Ancona, Italy

12. Hematology, San Camillo Forlanini Hospital, Rome, Italy

13. Medical Physics Unit, Santa Croce e Carle Hospital, Cuneo, Italy

14. Hematology, Santa Croce e Carle Hospital, Cuneo, Italy

15. Hematology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

16. Hematology, San Carlo Hospital, Potenza, Italy

17. Hematology, San Bortolo Hospital, Vicenza, Italy

18. Hematology Ospedale dell’Angelo, Mestre, Venice, Italy

19. Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

20. Nuclear Medicine Department, La Maddalena Hospital, Palermo, Italy

21. Onco-Hematology European Institute of Oncology, IRCCS, Milan, Italy

22. Department of Health Sciences, University of Milan, Milan, Italy

23. Nuclear Medicine, San Gerardo University Hospital, Monza, Italy

24. Department of Oncology-Hematology, University of Milan, Milan, Italy

Abstract

PURPOSE 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. PATIENTS AND METHODS 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). RESULTS 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%; P = .62) in subgroup A; 98% (95% CI, 93% to 100%) and 90% (95% CI, 80% to 100%; P = .24) in subgroup B; 89% (95% CI, 81% to 98%) and 86% (95% CI, 77% to 96%; P = .53) in subgroup C (classic bulky). CONCLUSION 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.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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