How does positron emission tomography-adapted therapy as first-line treatment affect outcomes in people with early-stage Hodgkin lymphoma?

2015 ◽  
Author(s):  
Simona Nistor-Grahl
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Emission Tomography ◽  
Line Treatment ◽  
First Line ◽  
Positron Emission ◽  
First Line Treatment

scholarly journals Predicted Risks of Cardiovascular Disease Following Chemotherapy and Radiotherapy in the UK NCRI RAPID Trial of Positron Emission Tomography–Directed Therapy for Early-Stage Hodgkin Lymphoma

2021 ◽  
pp. JCO.21.00408
Author(s):  
David J. Cutter ◽  
Johanna Ramroth ◽  
Patricia Diez ◽  
Andy Buckle ◽  
Georgios Ntentas ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Positron Emission Tomography ◽  
Cardiovascular Risk ◽  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Emission Tomography ◽  
Positron Emission ◽  
Increased Risk ◽  
Involved Field ◽  
Involved Field Radiotherapy

PURPOSE The contemporary management of early-stage Hodgkin lymphoma (ES-HL) involves balancing the risk of late adverse effects of radiotherapy against the increased risk of relapse if radiotherapy is omitted. This study provides information on the risk of radiation-related cardiovascular disease to help personalize the delivery of radiotherapy in ES-HL. METHODS We predicted 30-year absolute cardiovascular risk from chemotherapy and involved field radiotherapy in patients who were positron emission tomography (PET)–negative following three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy within a UK randomized trial of PET-directed therapy for ES-HL. Cardiac and carotid radiation doses and chemotherapy exposure were combined with established dose-response relationships and population-based mortality and incidence rates. RESULTS Average mean heart dose was 4.0 Gy (range 0.1-24.0 Gy) and average bilateral common carotid artery dose was 21.5 Gy (range 0.6-38.1 Gy), based on individualized cardiovascular dosimetry for 144 PET-negative patients receiving involved field radiotherapy. The average predicted 30-year radiation-related absolute excess overall cardiovascular mortality was 0.56% (range 0.01%-6.79%; < 0.5% in 67% of patients and > 1% in 15%), whereas average predicted 30-year excess incidence was 6.24% (range 0.31%-31.09%; < 5% in 58% of patients and > 10% in 24%). For cardiac disease, the average predicted 30-year radiation-related absolute excess mortality was 0.42% (0.79% with mediastinal involvement and 0.05% without) and for stroke, it was 0.14%. CONCLUSION Predicted excess cardiovascular risk is small for most patients, so radiotherapy may provide net benefit. However, for a minority of patients receiving high doses of radiation to cardiovascular structures, it may be preferable to consider advanced radiotherapy techniques to reduce doses or to omit radiotherapy and accept the increased relapse risk. Individual assessment of cardiovascular and other risks before treatment would allow personalized decision making about radiotherapy in ES-HL.

Positron Emission Tomography Status and Tandem High-Dose Therapy Favorably Influence Outcome of Patients with Relapsed and/or Refractory Hodgkin Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 335-335
Author(s):  
Raynier Devillier ◽  
Diane Coso ◽  
Luca Castagna ◽  
Isabelle Brenot-Rossi ◽  
Antonella Anastasia ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Emission Tomography ◽  
High Dose ◽  
Significant Prognostic Factor ◽  
First Line ◽  
Poor Outcome ◽  
Positron Emission ◽  
Refractory Hodgkin Lymphoma

Abstract Abstract 335 The cure of relapsed or refractory Hodgkin Lymphoma (HL) still remains a challenge. High dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care but almost half of patients relapse after ASCT and have poor outcome. Predictive factors including an interval from end of first line therapy to relapse shorter than 12 months, an Ann-Arbor stage III or IV at relapse, and relapse in previously irradiated field are currently used to identify patients with poor outcome. Development of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) assessment improves evaluation of response both in first line and salvage treatments. The aim of our study is first to confirm the predictive value of PET status before ASCT and then to compare ASCT strategy (single versus tandem) in patients with relapsed and/or refractory HL. We here report a series of 111 consecutive patients with relapsed and/or refractory HL who achieved at least partial remission (PR) at PET evaluation after one line of salvage chemotherapy and who underwent single or tandem ASCT. PET response assessment showed 85 (77%) patients in CR (PET- group) and 26 (23%) in PR (PET+ group). Five-year overall (OS) and progression free survival (PFS) were 81% and 64% respectively. There were significant differences in 5-year PFS (79% versus 23%, p<0.001) and 5-year OS (90% versus 55%, p=0.001) between PET- and PET+ groups respectively. This predictive value remained significant in both favorable/intermediate and unfavorable subgroups. In PET+ subgroup analysis, tandem ASCT dramatically improved 5-years PFS, from 0% to 43% (p=0.034) compared to single ASCT. Multivariate analysis showed that PET status (HR: 5.26 [2.57–10.73]) and tandem ASCT (HR: 0.39 [0.19–0.78]) but not relapse risk (HR: 1.77 [0.80–3.92]) significantly influenced PFS, while only PET status significantly influenced OS (HR: 4.03 [1.38–11.75]). Our results suggest that I) PET status before ASCT must be considered as a strong and significant prognostic factor influencing outcome and identifying high risk patients for more intensive strategy II) Tandem ASCT improved outcome compared to single ASCT, especially for PET+ patients. Disclosures: No relevant conflicts of interest to declare.

Predictive Value of Positron Emission Tomography/Computed Tomography After ABVD-Based Chemotherapy in Early-Stage Hodgkin Lymphoma

2019 ◽  
Vol 37 (34) ◽  
pp. 3324-3325 ◽  
Author(s):  
Carsten Kobe ◽  
Helen Goergen ◽  
Michael Fuchs ◽  
Horst Müller ◽  
Christan Baues ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Early Stage ◽  
Emission Tomography ◽  
Positron Emission
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