Post-Chemo Involved-Field RT Does Not Improve Overall Survival in Hodgkin Lymphoma

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(ChemotherapyAdvisor) – A long-term follow-up of children and young adults with Hodgkin's lymphoma who had a complete response to initial chemotherapy and treated with involved-field radiation therapy (IFRT) found event-free survival (EFS) but not overall survival (OS) to be statistically significantly improved, results of a study in the Journal of Clinical Oncology online May 29 has found.

The CCG 5942 study, the first to evaluate the impact of IRFT on EFS and OS in a randomized clinical trial, enrolled 826 eligible patentis between January 1995 and December 1998. Of these, 498 achieved an initial complete response to chemotherapy and were randomly assigned to IFRT or no further therapy, noted Suzanne L. Wolden, MD, of Memorial Sloan-Kettering Cancer Center, New York, NY, and colleagues.

Using final data through March 2007 — median follow-up was 7.7 years — long-term outcome showed 10-year EFS rate for the entire cohort to be 83.5%; OS was 92.5%. “In an as-treated analysis for randomly assigned patients, the 10-year EFS and OS rates were 91.2% and 97.1%, respectively, for IFRT and 82.9% and 95.9%, respectively, for no further therapy,” the investigators reported. For EFS and OS comparisons, P=0.004 and P=0.50, respectively. Risk factors for inferior EFS were bulk disease, “B” symptoms, and nodular sclerosis histology.

“In this trial, patients with either mixed cellularity or lymphocyte-predominant histology and clinical group 1 patients with nodular sclerosis histology and an initial ESR less than 20mm/h who achieved a complete response after chemotherapy were more likely to be cured with chemotherapy alone,” the authors wrote. “Going forward, we expect that early response to chemotherapy determined by anatomic and functional (FDG-PET) imaging will identify patients in whom therapy may be reduced. Additional long-term data on the late effects of current chemotherapy regimens as well as IFRT are needed,” they concluded.


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