Radiotherapy for early infradiaphragmatic Hodgkin's disease: the Australasian experience

Bartoň, Michael; Boyages, John; Crennan, Elizabeth; Davis, Sally J.; Fisher, Richard; Hook, Carolyn; Johnson, Neva; Joseph, David; Khoo, V.; Liew, Kuen Hoe; Morgan, Graeme; O’Brien, Peter C.; Pendlebury, Susan; Pratt, Gary; Quong, George; Roos, Daniel; Thornton, Deborah; Trotter, G.; Walker, Quenten; Wallington, Margaret

doi:10.1016/0167-8140(96)01715-x

Cited by 15 publications

(5 citation statements)

References 21 publications

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“…Some patients have been included in previous series. [17][18][19][20] Staging was according to the Ann Arbor system. 21 If involvement of a site was ambiguous, then it was coded as uninvolved, uncertain stage was coded as the lower of two possible stages, and B symptoms were coded as present only if they were unequivocal on chart review.…”

Section: Methodsmentioning

confidence: 99%

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Wirth

Yuen

Bartoň

et al. 2005

Cancer

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BACKGROUNDThe curative potential of radiotherapy (RT) alone as initial treatment for patients with Stage I–II lymphocyte‐predominant Hodgkin lymphoma (LPHL) has not been defined well.METHODSTwo hundred two patients who were treated between 1969 and 1995 were evaluated in a retrospective, multicenter study.RESULTSPatient characteristics were as follows: The median age was 31 years, 75% of patients were male, 80% of patients had Ann Arbor Stage I disease, 1% of patients had bulky disease, 3% of patients had B symptoms, 1% of patients had extranodal involvement, and 80% of patients had supradiaphragmatic disease. The RT fields were a full mantle field in 52% of patients, less than a full mantle field in 24% of patients, an inverted‐Y field in 17% of patients, less than an inverted‐Y field in 3% of patients, and total lymph node irradiation in 3% of patients. The median dose was 36 Gray. The median follow‐up was 15 years. The overall survival (OS) rate at 15 years was 83%, and freedom from progression (FFP) was observed in 82% of patients, including 84% of patients with Stage I disease and 73% of patients with Stage II disease. No recurrent LPHL and only 1 patient with non‐Hodgkin lymphoma (NHL) were reported after 15 years. Adverse prognostic factors that were identified on multifactor analysis were as follows: for OS, age 45 years or older (P < 0.0005), the presence of B symptoms (P = 0.002), increasing number of sites (P = 0.015); for FFP, increasing number of sites (P = 0.002). No significant difference was found in FFP in a comparison of patients who received elective mediastinal RT with patients who did not receive mediastinal RT (P = 0.11). Causes of death at 15 years were LPHL in 3% of patients, NHL in 2% of patients, in‐field malignancy in 2% of patients, in‐field cardiac/respiratory in 4% of patients, and other in 6% of patients.CONCLUSIONSThe current data suggested that RT potentially may be curative for patients with Stage I–II LPHL and raise the possibility that limited‐field RT may be used without loss of treatment efficacy. Involved‐field RT warrants further investigation for patients with early‐stage LPHL. Cancer 2005. © 2005 American Cancer Society.

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Section: Methodsmentioning

confidence: 99%

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Wirth

Yuen

Bartoň

et al. 2005

Cancer

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“…Chemo-radiotherapy might therefore be more efficient to control the disease. None of the previous studies focusing on IDHL found this difference, perhaps because of the small number of patients included [ 3 , 8 - 11 , 32 ]. In SDHL, two large randomized phase III trials (the RAPID trial [ 33 ] and the H10 trial [ 34 ]) underlined the importance of radiotherapy consolidation to reduce the risk of relapse.…”

Section: Discussionmentioning

confidence: 88%

Infradiaphragmatic Hodgkin lymphoma: a large series of patients staged with PET-CT

et al. 2017

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IntroductionInfradiaphragmatic Hodgkin Lymphoma (IDHL) accounts for 3-11% of adult cases of stage I-II Hodgkin Lymphoma and the treatment strategy in IDHL is still heterogeneous. All previous published studies were conducted before the PET-CT era. PET may provide a more accurate evaluation of IDHL stage. The aim of this study was to analyze the clinical and biological characteristics of IDHL patients staged by CT scan or PET-CT in eight French hematology departments and their impact on outcomes in these patients.MethodsBaseline clinical and biological data and outcomes in patients with a first diagnosis of stage I-II IDHL treated with ABVD +/- radiotherapy were retrospectively collected.ResultsAmong the 99 patients included, 65 (66%) were staged with PET-CT. These patients were older (53 years vs 46 years, p=0.043), had lower ESR (27 vs 58mm, p=0.022), higher hemoglobin level (13.6 vs 12.8g/dL, p=0.015), less frequent Ann Arbor stage II (74% vs 91%) and less central adenopathy involvement (60% vs 82%, p=0.024). Treatment was chemotherapy alone in 55% of patients and the remaining patients received chemo-radiotherapy (CRT). Five-year PFS and OS rates in PET-CT-staged patients were 78% (95% CI 64-87) and 88% (95% CI 73-95), respectively, compared with 65% (p=0.225) and 82% (p=0.352) in CT-staged patients. The CRT strategy was associated with fewer relapses (p=0.027).ConclusionThis study showed that the characteristics of CT-staged IDHL patients were less favorable than those of PET-CT-staged patients and indicated that CRT provided better PFS than did chemotherapy alone.

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“…There are controversial results about the prognosis of IDHL in comparison to stage I/II supradiaphragmatic disease in the literature. All the studies compared them with their classical prognostic factors with limited numbers of patients and different treatment approaches 10,12,15 . After evaluation of all potential risk factors affecting metastasis/recurrence with univariate cox regression analysis and multivariate model sex, TLG and bulky disease were found to be statistically significant risk factors for disease free survival time in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Although important subjects about prognostic factors and optimal treatment of isolated infradiaphragmatic HL have not been clearly determined, it is know that IDHL is characterized by higher male/female ratio, older patients' age at diagnosis and higher prevalence of lymphocyte-predominant histologic subtype in relation to supradiaphragmatic HL [8][9][10][11][12][13] . Whether pure infradiaphragmatic localization has a worse prognosis than stage I/II supradiaphragmatic disease has still remained controversial 9,[14][15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

Prognostic importance of metabolic tumor parameters on initial FDG-PET/CT in patients with isolated infradiaphragmatic Hodgkin’s lymphoma

et al. 2017

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Background/Aim. Isolated infradiaphragmatic lymph node involvement is not common and makes up 5-13% of stage I-II Hodgkin's lymphoma. Important subjects about prognostic factors and optimal treatment of isolated infradiaphragmatic Hodgkin's lymphoma (II HL) have not been clearly defined. We aimed to evaluate the prognostic value of metabolic tumor indices on initial 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) through quantitative PET/CT parameters together with the classical predefined risk factors for patients with II HL. Methods. This retrospective cohort study conducted between 2004 and 2015 included 21 patients for whom FDG-PET/CT were requested for primary staging. Quantitative PET/CT parameters (maximum standardized uptake value-SUV max) average standardized uptake value-SUV mean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were used to estimate disease-free survival and overall survival. Results. Univariate Cox regression analysis was performed for all potential risk factors impacting metastasis/recurrence of the disease. Factors which had values of p < 0.2 after univariate analysis (sex, age, stage, bulky disease, SUV max, SUV mean, MTV, TLG) were processed with the multivariate model. Sex, TLG and bulky disease were found to be statistically significant risk factors for prognosis of outcome in patients with IIHL after multivariate analysis. Conclusion. The existence of bulky disease at the diagnosis and high TLG values on primary staging by FDG-PET/CT are potential risk factors for both disease-free survival and overall survival in Hodgkin's lymphoma with isolated infradiaphragmatic lymph node involvement.

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Radiotherapy for early infradiaphragmatic Hodgkin's disease: the Australasian experience

Cited by 15 publications

References 21 publications

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Infradiaphragmatic Hodgkin lymphoma: a large series of patients staged with PET-CT

Prognostic importance of metabolic tumor parameters on initial FDG-PET/CT in patients with isolated infradiaphragmatic Hodgkin’s lymphoma

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