Analyses of patterns-of-failure and prognostic factors according to radiation fields in early-stage Hodgkin lymphoma.
OBJECTIVE
Doses and volumes of radiation therapy (RT) for early stages of Hodgkin lymphoma (HL) have been reduced over the last 30 years. Combined modality therapy (CMT) is currently the standard treatment for most patients with early-stage HL. The aim of this study was to analyze the site of relapse after RT according to the extent of radiation fields.


METHODS
Between 1987 and 2011, 427 patients were treated at our institution with RT ± chemotherapy for stage-I/II HL. Among these, 65 patients who experienced a relapse were retrospectively analyzed. Most patients had nodular sclerosis histology (86 %) and stage-II disease (75.9 %). Bulky disease was present in 21 % and 56 % of patients belonged to the unfavorable risk group according to European Organization for Research and Treatment of Cancer (EORTC)/The Lymphoma Study Association (LYSA) definitions. CMT was delivered to 91 % of patients. All patients received RT with doses ranging from 20 to 45 Gy (mean = 34 ± 5.3 Gy). The involved-field RT technique was used in 59 % of patients.


RESULTS
The mean time between diagnosis and relapse was 4.2 years (range 0.3-24.5). Out-of-field relapses were suffered by 53 % of patients. Relapses occurred more frequently at out-of-field sites in patients with a favorable disease status, whereas in-field relapses were associated with bulky mediastinal disease. Relapses occurred later for favorable compared with the unfavorable risk group (3.5 vs. 2.9 years, p = 0.5). From multivariate analyses, neither RT dose nor RT field size were predictive for an in-field relapse (p = 0.25 and p = 0.8, respectively), only bulky disease was predictive (p = 0.018).


CONCLUSIONS
In patients with bulky disease, RT dose and RT field size were not predictive for an in-field relapse. In this subgroup of patients, chemotherapy should be intensified. We confirmed the bad prognosis of early relapses.
Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France.
Lorraine
L
Krebs
Hematooncology Department, Saint Louis Hospital, AP-HP, Paris, France.
Sandy
S
Amorin
Hematooncology Department, Saint Louis Hospital, AP-HP, Paris, France.
Pauline
P
Brice
Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France.
Sophie
S
Guillerm
Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France.
Jean
J
Menard
Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France.
Christophe
C
Hennequin
Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France. laurent.quero@sls.aphp.fr.
Laurent
http://orcid.org/0000-0002-8781-2540
L
Quéro
D000328:Adult; D059248:Chemoradiotherapy / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D015995:Prevalence; D011379:Prognosis; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
Combined modality therapy; Hodgkin Lymphoma; Radiotherapy; Recurrence; Survival