title: Radiation therapy overcomes adverse prognostic role of cyclooxygenase-2 expression on Reed-Sternberg cells in early Hodgkin lymphoma.
abstract: OBJECTIVE
  To analyze the role of radiation therapy (RT) on the adverse prognostic influence of cyclooxygenase-2 (COX-2) expression on Reed-Sternberg (RS) cells, in the setting of early Hodgkin lymphoma (HL) treated with ABVD (adriamycin, vinblastine, bleomycin, dacarbazine).
  
  
  METHODS
  In the present study we retrospectively investigated the prognostic value of COX-2 expression in a large (n=143), uniformly treated early HL population from the Spanish Network of HL using tissue microarrays. Univariate and multivariate analyses were done, including the most recognized clinical variables and the potential role of administration of adjuvant RT.
  
  
  RESULTS
  Median age was 31 years; the expression of COX-2 defined a subgroup with significantly worse prognosis. Considering COX-2(+) patients, those who received RT had significantly better 5-year progression-free survival (PFS) (80% vs 54% if no RT; P=.008). In contrast, COX-2(-) patients only had a modest, nonsignificant benefit from RT in terms of 5-year PFS (90% vs 79%; P=.13). When we compared the outcome of patients receiving RT considering the expression of COX-2 on RS cells, we found a nonsignificant 10% difference in terms of PFS between COX-2(+) and COX-2(-) patients (P=.09), whereas the difference between the 2 groups was important (25%) in patients not receiving RT (P=.04).
  
  
  CONCLUSIONS
  Cyclooxygenase-2 RS cell expression is an adverse independent prognostic factor in early HL. Radiation therapy overcomes the worse prognosis associated with COX-2 expression on RS cells, acting in a chemotherapy-independent way. Cyclooxygenase-2 RS cell expression may be useful for determining patient candidates with early HL to receive consolidation with RT.
authors.affiliation: Service of Radiation Therapy, University Hospital Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mestre
authors.affiliation: Service of Hematology, University Hospital Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain. Electronic address: antoniom.gutierrez@ssib.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: MD Anderson Cancer Center, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rodriguez
authors.affiliation: Service of Pathology, University Hospital Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Spanish National Cancer Research Centre, Madrid, Spain.
authors.forename: Juan Fernando
authors.initials: JF
authors.lastname: Garcia
authors.affiliation: Service of Hematology, University Hospital Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Martinez-Serra
authors.affiliation: Service of Radiation Therapy, Policlinica Miramar, Palma de Mallorca, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Casasus
authors.affiliation: Service of Radiation Therapy, Policlinica Miramar, Palma de Mallorca, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Nicolau
authors.affiliation: Service of Hematology, University Hospital Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.
authors.forename: Leyre
authors.initials: L
authors.lastname: Bento
authors.affiliation: Service of Hematology, University Hospital Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.
authors.forename: Ines
authors.initials: I
authors.lastname: Herraez
authors.affiliation: Service of Radiology, IDISPA, Palma de Mallorca, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Lopez-Perezagua
authors.affiliation: Service of Nuclear Medicine, IDISPA, Palma de Mallorca, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Daumal
authors.affiliation: Service of Hematology, University Hospital Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Besalduch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001761:Bleomycin; D002648:Child; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D003606:Dacarbazine; D018572:Disease-Free Survival; D004317:Doxorubicin; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000201:enzymology* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016539:Reed-Sternberg Cells / Q000201:enzymology*; D012189:Retrospective Studies; D046888:Tissue Array Analysis; D047368:Tumor Burden; D014747:Vinblastine; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D051546:Cyclooxygenase 2