TY - JOUR

T1 - Patterns of relapse and long-term outcome in patients treated with a curative intent for advanced Hodgkin lymphoma

AU - Nielsen, Karin

AU - Maraldo, Maja Vestmoe

AU - Berthelsen, Anne Kiil

AU - Loft, Annika

AU - Brown, Peter de Nully

AU - Vogelius, Ivan Richter

AU - Petersen, Peter Meidahl

AU - Specht, Lena

N1 - Publisher Copyright: © 2022 Acta Oncologica Foundation.

PY - 2022

Y1 - 2022

N2 - Background: Consolidation radiotherapy for advanced Hodgkin lymphoma (AHL) is controversial. Precise knowledge of the most likely relapse location is crucial for radiotherapy planning. We performed detailed patterns of relapse analyses and evaluated if initial bulky disease, initial 18F-fluoro-deoxy-glucose (FDG)-avidity and/or a residual mass on computed tomography (CT)-scan after chemotherapy are sites with a high risk of relapse. This information could provide guidance for optimal use of radiotherapy in AHL. Material and methods: We included 133 patients treated with curatively intended chemotherapy for AHL. 23 patients received consolidation radiotherapy. For relapsed patients, imaging from diagnosis, response evaluation, relapse, and any radiotherapy planning, were retrieved and co-registered to determine the exact site(s) of relapse relative to initial site(s), residual mass(es) and to any irradiated volumes. Size and FDG-avidity of initial sites with later relapse, and residual CT-abnormalities after chemotherapy in these sites were registered. Survival analyses were done using the Kaplan–Meier method. Results: Nine (6.8%) patients relapsed, eight in initially involved sites. One relapse was in an initially irradiated site (as well as other sites). Initial bulky disease, high initial FDG-uptake, and/or residual masses on CT-scan after chemotherapy did not predict sites with a high risk of relapse. Overall survival was 79.6% (95% CI, 72.7–86.5%) and 70.6% (95% CI, 62.4–78.8%) at 5 and 10 years, respectively. Time to progression analysis showed 91.8% (95% CI, 86.9–96.7%) and 90.7% (95% CI, 85.4–96.0%) without progression at 5 and 10 years, respectively. Conclusion: Current treatment strategies for AHL provide excellent disease control. Neither initial bulk, high initial FDG-uptake, nor a residual CT-abnormality post-chemotherapy seem to indicate sites with a high risk of relapse.

AB - Background: Consolidation radiotherapy for advanced Hodgkin lymphoma (AHL) is controversial. Precise knowledge of the most likely relapse location is crucial for radiotherapy planning. We performed detailed patterns of relapse analyses and evaluated if initial bulky disease, initial 18F-fluoro-deoxy-glucose (FDG)-avidity and/or a residual mass on computed tomography (CT)-scan after chemotherapy are sites with a high risk of relapse. This information could provide guidance for optimal use of radiotherapy in AHL. Material and methods: We included 133 patients treated with curatively intended chemotherapy for AHL. 23 patients received consolidation radiotherapy. For relapsed patients, imaging from diagnosis, response evaluation, relapse, and any radiotherapy planning, were retrieved and co-registered to determine the exact site(s) of relapse relative to initial site(s), residual mass(es) and to any irradiated volumes. Size and FDG-avidity of initial sites with later relapse, and residual CT-abnormalities after chemotherapy in these sites were registered. Survival analyses were done using the Kaplan–Meier method. Results: Nine (6.8%) patients relapsed, eight in initially involved sites. One relapse was in an initially irradiated site (as well as other sites). Initial bulky disease, high initial FDG-uptake, and/or residual masses on CT-scan after chemotherapy did not predict sites with a high risk of relapse. Overall survival was 79.6% (95% CI, 72.7–86.5%) and 70.6% (95% CI, 62.4–78.8%) at 5 and 10 years, respectively. Time to progression analysis showed 91.8% (95% CI, 86.9–96.7%) and 90.7% (95% CI, 85.4–96.0%) without progression at 5 and 10 years, respectively. Conclusion: Current treatment strategies for AHL provide excellent disease control. Neither initial bulk, high initial FDG-uptake, nor a residual CT-abnormality post-chemotherapy seem to indicate sites with a high risk of relapse.

KW - Hodgkin lymphoma

KW - image co-registration

KW - radiotherapy

KW - relapse location

U2 - 10.1080/0284186X.2022.2114377

DO - 10.1080/0284186X.2022.2114377

M3 - Journal article

C2 - 36103605

AN - SCOPUS:85138415465

VL - 61

SP - 1056

EP - 1063

JO - Acta Oncologica

JF - Acta Oncologica

SN - 1100-1704

IS - 9

ER -