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Rosenbrock J, Kaul H, Oertel M, Celik E, Linde P, Fan J, Eichenauer DA, Bröckelmann PJ, von Tresckow B, Kobe C, Dietlein M, Fuchs M, Borchmann P, Eich HT, Baues C. Involved-site Radiation Therapy is Equally Effective and Less Toxic Than Involved-field Radiation Therapy in Patients Receiving Combined Modality Treatment for Early-stage Unfavorable Hodgkin Lymphoma-An Analysis of the Randomized Phase 3 HD17 Trial of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00514-5. [PMID: 38631539 DOI: 10.1016/j.ijrobp.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Combined modality treatment with chemotherapy followed by consolidation radiation therapy (RT) provides excellent outcomes for patients with early-stage Hodgkin lymphoma. The international standard of care for consolidation RT, involved-site/involved-node radiation therapy (ISRT/INRT), has never been evaluated in a randomized phase 3 trial against the former standard involved-field radiation therapy (IFRT). METHODS AND MATERIALS In the multicenter phase 3 GHSG (German Hodgkin Study Group) HD17 trial, patients with early-stage unfavorable Hodgkin lymphoma were randomized between the standard Combined modality treatment group and a positron-emission tomography (PET)-guided group. In the standard group, patients received 2 cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) and 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy IFRT. In the experimental group, patients received no further therapy if postchemotherapy PET was negative and 30 Gy GHSG INRT, comparable to and therefore termed here ISRT, if PET was positive. Here, we analyze the interim PET-positive patients in a post hoc analysis, and therefore the randomized comparison of IFRT versus INRT/ISRT. RESULTS A total of 1100 patients were randomized, of which 311 had a positive PET after chemotherapy. Kaplan-Meier estimates of 4-year progression-free survival were 96.8% (95% CI, 91.6%-98.8%) in the IFRT group and 95.4% (95% CI, 89.9%-97.9%; HR, 1.40; 95% CI, 0.44-4.42) in the ISRT group. The pattern of recurrence analyses indicated that none of the cases of disease progression or recurrence in the ISRT group would have been prevented by the use of IFRT. Acute grade 3/4 toxicities occurred in 8.5% of IFRT patients and 2.6% of ISRT patients (P = .03). CONCLUSIONS For the first time, consolidation INRT/ISRT was randomly compared with IFRT in a phase 3 trial. Regarding progression-free survival, no advantage of IFRT could be demonstrated. In summary, our data confirm the status of INRT/ISRT as the current standard of care.
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Affiliation(s)
- Johannes Rosenbrock
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Helen Kaul
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Michael Oertel
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Linde
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jiaqi Fan
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Paul J Bröckelmann
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG); Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG); Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group (GHSG); Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Hans Theodor Eich
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Christian Baues
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
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Galunic Bilic L, Santek F, Mitrovic Z, Basic-Kinda S, Dujmovic D, Vodanovic M, Mandac Smoljanovic I, Ostojic Kolonic S, Galunic Cicak R, Aurer I. Long-Term Results of IFRT vs. ISRT in Infradiaphragmal Fields in Aggressive Non-Hodgkins's Lymphoma Patients-A Single Centre Experience. Cancers (Basel) 2024; 16:649. [PMID: 38339400 PMCID: PMC10854861 DOI: 10.3390/cancers16030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: This study aimed to examine the difference in efficacy and toxicity of involved-field (IFRT) and involved-site radiotherapy (ISRT) fields in infradiaphragmal aggressive non-Hodgkin lymphoma patients. (2) Methods: In total, 140 patients with infradiaphragmal lymphoma treated between 2003 and 2020 were retrospectively evaluated. There were 69 patients (49%) treated with IFRT, and 71 (51%) patients treated with ISRT. The median dose in the IFRT group was 36 Gy, (range 4-50.4 Gy), and in the ISRT group, it was 30 Gy (range 4-48 Gy). (3) Results: The median follow-up in the IFRT group was 133 months (95% CI 109-158), and in the ISRT group, it was 48 months (95% CI 39-57). In the IFRT group, locoregional control was 67%, and in the ISRT group, 73%. The 2- and 5-year overall survival (OS) in the IFRT and ISRT groups were 79% and 69% vs. 80% and 70%, respectively (p = 0.711). The 2- and 5-year event-free survival (EFS) in the IFRT and ISRT groups were 73% and 68% vs. 77% and 70%, respectively (p = 0.575). Acute side effects occurred in 43 (31%) patients, which is more frequent in the IFRT group, 34 (39%) patients, than in the ISRT group, 9 (13%) patients, p > 0.01. Late toxicities occurred more often in the IFRT group of patients, (10/53) 19%, than in the ISRT group of patients, (2/37) 5%, (p = 0.026). (4) Conclusions: By reducing the radiotherapy volume and the doses in the treatment of infradiaphragmatic fields, treatment with significantly fewer acute and long-term side effects is possible. At the same time, efficiency and local disease control are not compromised.
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Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, 10000 Zagreb, Croatia
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Ruzica Galunic Cicak
- Department of Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Igor Aurer
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
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Nassi L, De Sanctis V, Loseto G, Gerardi C, Allocati E, Ciavarella S, Minoia C, Guarini A, Bari A. Second Cancers in Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma: A Systematic Review by the Fondazione Italiana Linfomi. Cancers (Basel) 2022; 14:cancers14030519. [PMID: 35158787 PMCID: PMC8833346 DOI: 10.3390/cancers14030519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The increase of lymphoma patient survival led to a modification of the incidence of long-term sequelae, including second malignancies (SM). Several groups have dealt with the incidence of SM, according to the primary treatment; however, a standardized approach for the early detection and screening of SM in the population of lymphoma survivors should be implemented. METHODS A systematic review was conducted by Fondazione Italiana Linfomi (FIL), in order to define the incidence of SM, the impact of modern radiotherapy on SM risk, and the usefulness of tailored follow-up and screening strategies for early diagnosis of SM. Classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) survivors were investigated. The MEDLINE, Embase, and Cochrane Library databases were checked for relevant reports published up to January 2020. The selection process was reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS A total of 27 full-text manuscripts resulted as eligible for the analysis. The incidence of SM in cHL patients treated with ABVD was higher compared to the general population and was even higher in patients treated with intensified regimens. The risk increased over time, as well as after 10-15 years from therapy, and was augmented by radiotherapy exposure. In DLBCL, more intensive regimens (i.e., R-CHOEP or R-MegaCHOEP) vs. R-CHOP were associated with a higher SM incidence. Salvage chemotherapy and autologous stem cell transplants increased the risk of SM in both cHL and DLBCL cohorts. A lower incidence of SM, particularly of breast cancer (BC), was shown in cohorts of cHL survivors treated with reduced radiation volumes and doses (involved fields vs. extended fields), but robust trials are still lacking. Considering the advantage of a structured screening for early detection of SM, all the included studies regarded cHL survivors and screening strategy for early BC detection. Moreover, the authors discuss additional papers, to guide the early diagnosis of lung, colorectal, skin, and thyroid cancer in patients at risk due to family history, drug or RT exposure, or unhealthy lifestyles. These screening strategies all passed through patient awareness. CONCLUSION A modern approach to chemotherapy and radiotherapy led to a lower risk of SM, which should be confirmed over time. Early detection of secondary cancers could be achieved through a tailored screening program, according to the individual risk profile.
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Affiliation(s)
- Luca Nassi
- Department of Hematology, Careggi Hospital and University of Florence, 50134 Florence, Italy
- Correspondence:
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Faculty of Medicina e Psicologia, Sant’Andrea Hospital, University of Rome “La Sapienza”, 00185 Rome, Italy;
| | - Giacomo Loseto
- Hematology Unit—IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (G.L.); (S.C.); (C.M.); (A.G.)
| | - Chiara Gerardi
- Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, 20156 Milan, Italy; (C.G.); (E.A.)
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, 20156 Milan, Italy; (C.G.); (E.A.)
| | - Sabino Ciavarella
- Hematology Unit—IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (G.L.); (S.C.); (C.M.); (A.G.)
| | - Carla Minoia
- Hematology Unit—IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (G.L.); (S.C.); (C.M.); (A.G.)
| | - Attilio Guarini
- Hematology Unit—IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (G.L.); (S.C.); (C.M.); (A.G.)
| | - Alessia Bari
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, Universita’ di Modena e Reggio Emilia, 41124 Modena, Italy;
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Rosenbrock J, Baues C, Vasquez-Torres A, Clivio A, Fogliata A, Borchmann P, Marnitz S, Cozzi L. Volumetric modulated arc therapy versus intensity-modulated proton therapy in the irradiation of infra diaphragmatic Hodgkin Lymphoma in female patients. Acta Oncol 2022; 61:81-88. [PMID: 34596491 DOI: 10.1080/0284186x.2021.1986230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the role of infra diaphragmatic intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for female Hodgkin Lymphoma (HL) patients and to estimate the risk of secondary cancer and ovarian failure. METHODS A comparative treatment planning study was performed on 14 patients, and the results were compared according to conventional dose-volume metrics. In addition, estimates of the excess absolute risk (EAR) of secondary cancer induction were determined for the bowel, the bladder and the rectum. For the ovaries, the risk of ovarian failure was estimated. RESULTS The dosimetric findings demonstrate the equivalence between VMAT and IMPT in terms of target coverage. A statistically significant reduction of the mean and near-to-maximum doses was proven for the organs at risk. The EAR ratio estimated for IMPT to VMAT was 0.51 ± 0.32, 0.32 ± 0.35 and 0.05 ± 0.11 for the bowel, bladder and rectum, respectively. Concerning the risk of ovarian failure for the chronologic age ranging from 18 to 46 years, the expected net loss in fertility years ranged from 4.8 to 3.0 years for protons and 12.0 to 5.7 years for photons. CONCLUSION This in-silico study confirmed the beneficial role of IMPT from a dosimetric point of view. Mathematical models suggested that the use of protons might be further advantageous due to the expected reduction of the risk of secondary cancer induction and its milder impact on the reduction of fertility.
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Affiliation(s)
- Johannes Rosenbrock
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andres Vasquez-Torres
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Peter Borchmann
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Simone Marnitz
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
- Department of Hematology and Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Rosenbrock J, Vásquez-Torres A, Mueller H, Behringer K, Zerth M, Celik E, Fan J, Trommer M, Linde P, Fuchs M, Borchmann P, Engert A, Marnitz S, Baues C. Involved Site Radiotherapy Extends Time to Premature Menopause in Infra-Diaphragmatic Female Hodgkin Lymphoma Patients - An Analysis of GHSG HD14- and HD17-Patients. Front Oncol 2021; 11:658358. [PMID: 34113567 PMCID: PMC8185193 DOI: 10.3389/fonc.2021.658358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/06/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Consolidation radiotherapy in intermediate stage Hodgkin´s lymphoma (HL) has been the standard of care for many years as involved field radiotherapy (IFRT) after chemotherapy. It included initially involved region(s). Based on randomized studies, radiation volumes could be reduced and involved site radiation therapy (ISRT) became the new standard. ISRT includes the initially affected lymph nodes. In young adults suffering from HL, infertility and hypogonadism are major concerns. With regard to these questions, we analyzed the influence of modern radiotherapy concepts such as consolidating ISRT in infradiaphragmatic involvement of HL after polychemotherapy. Patients and Methods Five hundred twelve patients treated within German Hodgkin Study Group (GHSG) HD14 and HD17 trials were evaluated. We analyzed log-adjusted follicle-stimulating-hormone (FSH)- and luteinizing-hormone (LH)-levels of HD14-patients with infradiaphragmatic radiotherapy (IDRT) in comparison with HD14-patients, who had a supradiaphragmatic radiotherapy (SDRT). In a second step, we compared IFRT with ISRT of female HD17 patients regarding the effects on ovarian function and premature menopause. Results We analyzed FSH- and LH-levels of 258 female and 241 male patients, all treated with IFRT. Of these 499 patients, 478 patients had SDRT and 21 patients had IDRT. In a multiple regression model, we could show that log-adjusted FSH (p=0.0006) and LH values (p=0.0127) were significantly higher after IDRT than after SDRT. The effect of IDRT on gonadal function was comparable to two cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc). We compared the effect of IFRT with ISRT in thirteen female HD17 patients with infradiaphragmatic (ID) involvement. The mean ovarian dose after ISRT was significantly lower than after IFRT. The calculated proportion of surviving non-growing follicles (NGFs) increased significantly from 11.87% to 24.48% in ISRT compared to IFRT, resulting in a significantly longer calculated time to menopause. The younger the age at therapy, the greater the absolute time gain until menopause. Conclusion Infradiaphragmatic IFRT impairs gonadal function to a similar extent as two cycles of BEACOPPesc. In comparison, the use of ISRT target volume definition significantly reduced radiation dose to the ovaries and significantly extends the time interval from treatment to premature menopause.
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Affiliation(s)
- Johannes Rosenbrock
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrés Vásquez-Torres
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Horst Mueller
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karolin Behringer
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Hematology and Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Zerth
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eren Celik
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jiaqi Fan
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maike Trommer
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Linde
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Hematology and Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Hematology and Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Hematology and Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simone Marnitz
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Radiation Therapy Reference Center of the German Hodgkin Study Group (GHSG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Outcomes Following Breast Reconstruction in Patients With Prior Mantle Radiation for Treatment of Hodgkin's Lymphoma. Ann Plast Surg 2019; 84:507-511. [PMID: 31663939 DOI: 10.1097/sap.0000000000002087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE External beam radiation in the mantle field has been a mainstay of therapy for Hodgkin's lymphoma for decades. The incidence of breast cancer in patients treated with mantle radiation is known to be elevated. Few studies have examined outcomes of breast reconstruction in this high-risk group. The current study presents the largest series of immediate breast reconstruction in this population and aims to evaluate reconstructive outcomes and examine differences between implant-based and autologous reconstructions. METHODS A retrospective review of records from a 10-year period at 2 institutions was undertaken. Patients treated with mantle radiation for Hodgkin's lymphoma who subsequently underwent mastectomy with immediate reconstruction were identified. Patient demographics, clinical characteristics, and outcomes including complications and operative revisions were gathered. Univariate and multivariate analyses were conducted to assess differences between implant-based and autologous reconstructions. RESULTS A total of 97 breast reconstructions were performed in 52 patients. Seventy-nine reconstructions were implant-based, and 18 were autologous. Patients with implant-based reconstructions were older than autologous reconstructions (47 ± 8.8 years vs 42 ± 6.5 years, P < 0.05). Both groups had long-term follow-up; however, the mean follow-up duration was shorter in the implant-based compared with the autologous group (5 years vs 8.3 years; P < 0.05). Otherwise, the groups were similar with respect to BMI, medical comorbidities, oncologic diagnosis, and therapy. The interval between mantle radiation and reconstruction was comparable for implant-based and autologous groups (23.4 ± 9 years vs 21.3 ± 6.1 years, P = 0.6). The overall complication rate of breast reconstruction was not statistically different between the implant-based and autologous groups (35% vs 16%, P = 0.16). Three implant-based reconstructions (3.7%) required explantation. There were no complete flap losses in the autologous group. An associated 6-fold higher rate of unplanned revisions was observed with the autologous reconstruction group compared with the implant-based reconstruction group (odds ratio, 6.09; 95% confidence interval, 1.14-32.48; P = 0.035). CONCLUSIONS In this study, long-term follow-up suggests immediate breast reconstruction in patients with prior mantle radiation can be achieved safely with an acceptable complication profile utilizing either implant-based or autologous techniques. Autologous breast reconstruction is linked with a higher rate of revisions compared with implant-based breast reconstruction in this study population.
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