title: Relapse analysis of irradiated patients within the HD15 trial of the German Hodgkin Study Group.
abstract: OBJECTIVE
  To determine, in the setting of advanced-stage of Hodgkin lymphoma (HL), whether relapses occur in the irradiated planning target volume and whether the definition of local radiation therapy (RT) used by the German Hodgkin Study Group (GHSG) is adequate, because there is no harmonization of field and volume definitions among the large cooperative groups in the treatment of advanced-stage HL.
  
  
  METHODS
  All patients with residual disease of ≥ 2.5 cm after multiagent chemotherapy (CTX) were evaluated using additional positron emission tomography (PET), and those with a PET-positive result were irradiated with 30 Gy to the site of residual disease. We re-evaluated all sites of disease before and after CTX, as well as the PET-positive residual tumor that was treated in all relapsed patients. Documentation of radiation therapy (RT), treatment planning procedures, and portal images were carefully analyzed and compared with the centrally recommended RT prescription. The irradiated sites were compared with sites of relapse using follow-up computed tomography scans.
  
  
  RESULTS
  A total of 2126 patients were enrolled, and 225 patients (11%) received RT. Radiation therapy documents of 152 irradiated patients (68%) were analyzed, with 28 irradiated patients (11%) relapsing subsequently. Eleven patients (39%) had an in-field relapse, 7 patients (25%) relapsed outside the irradiated volume, and an additional 10 patients (36%) showed mixed in- and out-field relapses. Of 123 patients, 20 (16%) with adequately performed RT relapsed, compared with 7 of 29 patients (24%) with inadequate RT.
  
  
  CONCLUSIONS
  The frequency and pattern of relapses suggest that local RT to PET-positive residual disease is sufficient for patients in advanced-stage HL. Insufficient safety margins of local RT may contribute to in-field relapses.
authors: Department of Radiation Oncology, University of Münster, Münster, Germany.
authors: Jan
authors: J
authors: Kriz
authors: Department of Radiation Oncology, University of Münster, Münster, Germany.
authors: Gabriele
authors: G
authors: Reinartz
authors: Department of Nuclear Medicine, University of Cologne, Cologne, Germany.
authors: Markus
authors: M
authors: Dietlein
authors: Department of Nuclear Medicine, University of Cologne, Cologne, Germany.
authors: Carsten
authors: C
authors: Kobe
authors: Department of Nuclear Medicine, University of Cologne, Cologne, Germany.
authors: Georg
authors: G
authors: Kuhnert
authors: First Department of Internal Medicine, University of Cologne, Cologne, Germany.
authors: Heinz
authors: H
authors: Haverkamp
authors: Department of Radiation Oncology, University of Münster, Münster, Germany.
authors: Uwe
authors: U
authors: Haverkamp
authors: Department of Radiation Oncology, University of Marburg, Marburg, Germany.
authors: Rita
authors: R
authors: Engenhart-Cabillic
authors: Department of Radiation Oncology, University Heidelberg, Heidelberg, Germany.
authors: Klaus
authors: K
authors: Herfarth
authors: Department of Radiation Oncology, University of Innsbruck, Innsbruck, Austria.
authors: Peter
authors: P
authors: Lukas
authors: Department of Radiation Oncology, University of Mainz, Mainz, Germany.
authors: Heinz
authors: H
authors: Schmidberger
authors: Department of Radiation Oncology, Klinikum Bremen-Mitte, Bremen, Germany.
authors: Susanne
authors: S
authors: Staar
authors: Department of Radiation Oncology, University of Münster, Münster, Germany.
authors: Kira
authors: K
authors: Hegerfeld
authors: Department of Radiation Oncology, University of Cologne, Cologne, Germany.
authors: Christian
authors: C
authors: Baues
authors: First Department of Internal Medicine, University of Cologne, Cologne, Germany.
authors: Andreas
authors: A
authors: Engert
authors: Department of Radiation Oncology, University of Münster, Münster, Germany. Electronic address: hans.eich@ukmuenster.de.
authors: Hans Theodor
authors: HT
authors: Eich
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D019788:Fluorodeoxyglucose F18; D005858:Germany; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography / Q000379:methods; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012008:Recurrence; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone