Article

Long-Term Results of CCG 5942: A Randomized Comparison of Chemotherapy With and Without Radiotherapy for Children With Hodgkin's Lymphoma-A Report From the Children's Oncology Group

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, SM-17, New York, NY 10065
Journal of Clinical Oncology (Impact Factor: 18.43). 05/2012; 30(26):3174-80. DOI: 10.1200/JCO.2011.41.1819
Source: PubMed

ABSTRACT

PURPOSE In 1995, the Children's Cancer Group (CCG) opened a trial for patients with Hodgkin's lymphoma evaluating whether low-dose involved-field radiation therapy (IFRT) improved event-free survival (EFS) for patients achieving a complete response after chemotherapy. We present the long-term study outcome using final data through March 2007. PATIENTS AND METHODS Between January 1995 and December 1998, 826 eligible patients were enrolled onto CCG 5942. Four hundred ninety-eight patients achieving an initial complete response to chemotherapy were randomly assigned to receive IFRT or no further therapy. EFS and overall survival (OS) were assessed from the date of study entry or random assignment, as appropriate. Results Ten-year EFS and OS rates for the entire cohort were 83.5% and 92.5%, respectively. In an as-treated analysis for randomly assigned patients, the 10-year EFS and OS rates were 91.2% and 97.1%, respectively, for IFRT and 82.9% and 95.9%, respectively, for no further therapy. For EFS and OS comparisons, P = .004 and P = .50, respectively. Bulk disease, "B" symptoms, and nodular sclerosis histology were risk factors for inferior EFS. CONCLUSION With a median follow-up of 7.7 years, IFRT produced a statistically significant improvement in EFS but no improvement in OS. For individual patients, the relative risks of relapse versus late effects of IFRT must be considered. Patient and disease characteristics and early response assessment will aid in deciding which patients are most likely to benefit from IFRT.

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    • "After stratification for risk factors, a significant difference was evident for the low risk patients (89.1% vs. 100%, P=0.001), but not for the intermediate and high-risk groups (78.0% vs. 84% and 79.9% vs. 88.5%, respectively).18 Conversely, the GPOH-HD95 trial showed that the omission of RT was safe only for low-risk patients with complete response after chemotherapy (PFS of 96.8% versus 93.6%, p=0.42), whereas this strategy was not proven to be safe for the intermediate and the high risk groups (PFS 69.1% vs. 92.4%, "
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    • "Despite the relatively high overall survival for HL, the survivors are at risk of long-term complications and treatment-related mortality, especially pediatric, adolescent, and young adult patients. Recent trials in pediatric and adolescent HL have investigated chemotherapy regimens of varying dose intensities and reduction in radiotherapy usage based on risk group stratification.19–23 These approaches appeared to maintain the high response rate while reducing the burden of treatment. "
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    • "This reflects the inability of IPS index to identify a group of patients with sufficiently poor outcome, who may benefit from treatment intensification. Though there is no consensus among the different groups regarding riskstratification , several studies have shown bulky disease, B-symptoms and number of involved sites, nodular sclerosis histology (NS), and early response to therapy to be important prognostic factors[20,21,23,25,27]. Is it safe to omit radiation treatment in selected patients? "
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    ABSTRACT: The classic treatment of Hodgkin's lymphoma (HL) in children resulted in significant late toxicity in long-term survivors. Late treatment effects included skeletal, cardio- pulmonary, gonadal toxicities, and second malignant tumor (SMN). This has driven pediatric HL groups to adopt treatment strategies using less intense chemotherapy, less alkylating agents, reduced radiation dose and volume, and omission of radiation therapy in selected group of patients. In limited disease, the aim is to maintain a high cure rate with minimal side effects. Patients with advanced-stage HL have a lower outcome, and need treatment intensification. Dose-dense, risk and response-adapted treatment strategies are evolving aiming at improving outcome and reducing toxicity.
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