Predictive Factor Analysis of Response-Adapted Radiation Therapy for Chemotherapy-Sensitive Pediatric Hodgkin Lymphoma: Analysis of the Children's Oncology Group AHOD 0031 Trial

• Published in: International journal of radiation oncology, biology, physics Vol. 96; no. 5; pp. 943 - 950
• Main Authors: Charpentier, Anne-Marie, Friedman, Debra L., Wolden, Suzanne, Schwartz, Cindy, Gill, Bethany, Sykes, Jenna, Albert-Green, Alisha, Kelly, Kara M., Constine, Louis S., Hodgson, David C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2016
• Subjects: Adolescent; Anemia - blood; Anemia - complications; Anemia - mortality; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; BIOMEDICAL RADIOGRAPHY; Bleomycin - administration & dosage; CHEMOTHERAPY; Child; Child, Preschool; CHILDREN; Cyclophosphamide - administration & dosage; Disease-Free Survival; Doxorubicin - administration & dosage; Etoposide - administration & dosage; Factor Analysis, Statistical; Female; Hematology, Oncology and Palliative Medicine; Hodgkin Disease - drug therapy; Hodgkin Disease - mortality; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Humans; LYMPHOMAS; Male; Multivariate Analysis; Positron-Emission Tomography; Prednisone - administration & dosage; RADIATION HAZARDS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Risk Factors; Time Factors; Treatment Outcome; Tumor Burden; Vincristine - administration & dosage; Young Adult
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2016.07.015

To evaluate whether clinical risk factors could further distinguish children with intermediate-risk Hodgkin lymphoma (HL) with rapid early and complete anatomic response (RER/CR) who benefit significantly from involved-field RT (IFRT) from those who do not, and thereby aid refinement of treatment selection. Children with intermediate-risk HL treated on the Children's Oncology Group AHOD 0031 trial who achieved RER/CR with 4 cycles of chemotherapy, and who were randomized to 21-Gy IFRT or no additional therapy (n=716) were the subject of this study. Recursive partitioning analysis was used to identify factors associated with clinically and statistically significant improvement in event-free survival (EFS) after randomization to IFRT. Bootstrap sampling was used to evaluate the robustness of the findings. Although most RER/CR patients did not benefit significantly from IFRT, those with a combination of anemia and bulky limited-stage disease (n=190) had significantly better 4-year EFS with the addition of IFRT (89.3% vs 77.9% without IFRT; P=.019); this benefit was consistently reproduced in bootstrap analyses and after adjusting for other prognostic factors. Although most patients achieving RER/CR had favorable outcomes with 4 cycles of chemotherapy alone, those children with initial bulky stage I/II disease and anemia had significantly better EFS with the addition of IFRT as part of combined-modality therapy. Further work evaluating the interaction of clinical and biologic factors and imaging response is needed to further optimize and refine treatment selection.