title: Predictive Factor Analysis of Response-Adapted Radiation Therapy for Chemotherapy-Sensitive Pediatric Hodgkin Lymphoma: Analysis of the Children's Oncology Group AHOD 0031 Trial.
abstract: To evaluate whether clinical risk factors could further distinguish children with intermediate-risk Hodgkin lymphoma (HL) with rapid early and complete anatomic response (RER/CR) who benefit significantly from involved-field RT (IFRT) from those who do not, and thereby aid refinement of treatment selection.
  
  
  
  Children with intermediate-risk HL treated on the Children's Oncology Group AHOD 0031 trial who achieved RER/CR with 4 cycles of chemotherapy, and who were randomized to 21-Gy IFRT or no additional therapy (n=716) were the subject of this study. Recursive partitioning analysis was used to identify factors associated with clinically and statistically significant improvement in event-free survival (EFS) after randomization to IFRT. Bootstrap sampling was used to evaluate the robustness of the findings.
  
  
  
  Although most RER/CR patients did not benefit significantly from IFRT, those with a combination of anemia and bulky limited-stage disease (n=190) had significantly better 4-year EFS with the addition of IFRT (89.3% vs 77.9% without IFRT; P=.019); this benefit was consistently reproduced in bootstrap analyses and after adjusting for other prognostic factors.
  
  
  
  Although most patients achieving RER/CR had favorable outcomes with 4 cycles of chemotherapy alone, those children with initial bulky stage I/II disease and anemia had significantly better EFS with the addition of IFRT as part of combined-modality therapy. Further work evaluating the interaction of clinical and biologic factors and imaging response is needed to further optimize and refine treatment selection.
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Charpentier
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
authors.affiliation: Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wolden
authors.affiliation: Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Cindy
authors.initials: C
authors.lastname: Schwartz
authors.affiliation: Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Bethany
authors.initials: B
authors.lastname: Gill
authors.affiliation: Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jenna
authors.initials: J
authors.lastname: Sykes
authors.affiliation: Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Alisha
authors.initials: A
authors.lastname: Albert-Green
authors.affiliation: Division of Hematology and Oncology, Women & Children's Hospital of Buffalo, Buffalo, New York; Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Kara M
authors.initials: KM
authors.lastname: Kelly
authors.affiliation: Radiation Oncology, University of Rochester Medical Center, Rochester, New York.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: David.hodgson@rmp.uhn.on.ca.
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000097:blood / Q000150:complications* / Q000401:mortality; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005163:Factor Analysis, Statistical; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone