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Luna-Fineman S, Castellanos M, Metzger ML, Baez LF, Peña Hernandez A, Bonilla M, Fuentes-Alabi S, Nieves R, Blanco J, Rossi E, Devidas M, Chen Y, Arreola M, de Alarcon PA. Treatment of high-risk Hodgkin lymphoma with a modified Stanford V regimen in the AHOPCA: Substituting chemotherapy agents and hampered outcomes. Pediatr Blood Cancer 2024; 71:e30792. [PMID: 38053237 DOI: 10.1002/pbc.30792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND/OBJECTIVES High-risk Hodgkin lymphoma (HRHL) in children is curable with combined modality therapy. The Association of Pediatric Hematology-Oncology of Central America (AHOPCA) is a consortium of cancer centers from Central America. In 2004, AHOPCA implemented a guideline with a short course of chemotherapy (mStanfordV), strict diagnostics, and radiation guidelines, aimed at reducing abandonment and improving outcomes. METHODS Newly diagnosed children less than 18 years of age with high-risk HL (Ann Arbor stages: IIB, IIIB, IV) from AHOPCA centers were staged with chest radiography and ultrasound or computed tomography. Therapy was a modified Stanford V (mStanfordV), substituting cyclophosphamide for mechlorethamine and involved field radiation. RESULTS Of 219 patients with HRHL, 181 patients were eligible and evaluable; 146 (81%) were boys, 22% being less than 6 years; 43 were stage IIB, 84 IIIB, and 54 IV. Thirty-one (17%) abandoned therapy, 28 (15%) progressed, 30 (17%) relapsed, and eight (4%) died of toxicity. Radiation guidelines were not followed. Five-year abandonment-sensitive event-free survival and overall survival (AS-EFS, AS-OS ± SE) for the cohort were 46% ± 4% and 56% ± 4%; 5-year AS-OS for stages IIB, IIIB, and IV was 76% ± 7%, 59% ± 7%, and 35% ± 7% (p = .0006). CONCLUSION Despite instituting a short treatment guideline, it did not improve the abandonment rate (17%) and did not achieve the reported outcomes of Stanford V. The cyclophosphamide dose used to replace merchlorethamine was inadequate. Despite strict guidelines, the radiation therapy application was inaccurate. Weekly chemotherapy may have adversely affected abandonment of therapy by increasing the burden of travel time. Based on these results, AHOPCA established a new abandonment strategy and a new guideline.
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Affiliation(s)
- Sandra Luna-Fineman
- Hematology/Oncology/SCT, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
- Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala, Guatemala
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | | | - L Fulgencio Baez
- Oncología Pediátrica, Hospital Manuel de Jesús Rivera "La Mascota", Managua, Nicaragua
| | - Armando Peña Hernandez
- Oncología Pediátrica, Hospital Escuela Universitario Materno Infantil, Tegucigalpa, Honduras
| | - Miguel Bonilla
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Soad Fuentes-Alabi
- Oncología Pediátrica, Hospital de Niños Benjamín Bloom, Centro Médico "Ayúdame a Vivir", San Salvador, El Salvador
| | - Rosa Nieves
- Oncología Pediátrica, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Jessica Blanco
- Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala, Guatemala
- Center for Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Emanuela Rossi
- Center for Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Meenakshi Devidas
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yichen Chen
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Magda Arreola
- Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala, Guatemala
| | - Pedro A de Alarcon
- Department of Pediatrics, University of Illinois College of Medicine and St Jude Midwest Affiliate Children's Hospital of Illinois, Peoria, Illinois, USA
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2
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Pediatric radiotherapy for thoracic and abdominal targets: organ motion, reported margin sizes, and delineation variations – a systematic review. Radiother Oncol 2022; 173:134-145. [DOI: 10.1016/j.radonc.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022]
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3
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DE Sanctis V, DI Rocco A, Cox MC, Valeriani M, Congedi FP, Anzellini D, Massaro M, Vullo G, Facondo G, DE Giacomo F, Alfò M, Prosperi D, Pizzichini P, Pelliccia S, Tafuri A, Martelli M, Osti MF. Residual Site Radiotherapy After Immunochemotherapy in Primary Mediastinal B-Cell Lymphoma: A Monoinstitutional Retrospective Study. In Vivo 2021; 34:1407-1413. [PMID: 32354938 DOI: 10.21873/invivo.11921] [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: 02/24/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Abstract
AIM To evaluate the efficacy of residual site radiation therapy (RSRT) on local control (LC), progression-free (PFS) and overall (OS) survival in patients with primary mediastinal lymphoma (PMBCL), following rituximab and chemotherapy treatment (ICHT). PATIENTS AND METHODS The study included 34 patients with PMBCL treated between 2006 and 2014 with ICHT with/without autologous stem cell transplantation and RSRT. Between the end of ICHT/stem cell transplantation and RSRT, patients were evaluated with 18F-fluorodeoxyglucose positron-emission tomography. The gross tumor volume included morphological mediastinal residual disease after ICHT/SCT. The percentage of LC, PFS and OS were assessed. RESULTS All patients received RSRT with a median dose of 30 Gy. Median follow-up was 82 months. One patient out of 34 (3%) showed progressive disease 9 months from diagnosis. The 10-year PFS and OS were 97% and 97% respectively. CONCLUSION RSRT in patients with PMBCL treated with ICHT did not impact unfavorably on LC and patient survival.
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Affiliation(s)
- Vitaliana DE Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Alice DI Rocco
- Department of Translational and Precision Medicine, Hematology Institute, Sapienza University of Rome, Rome, Italy
| | - Maria Christina Cox
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Francesca Perrone Congedi
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Maria Massaro
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Giuseppe Facondo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Flavia DE Giacomo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marco Alfò
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Prosperi
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pizzichini
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabrina Pelliccia
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Agostino Tafuri
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.,Department of Clinic and Molecular Medicine and Hematology, Sapienza, University of Rome and S. Andrea University Hospital of Rome, Rome, Italy
| | - Maurizio Martelli
- Department of Translational and Precision Medicine, Hematology Institute, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
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4
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Kourinou KM, Mazonakis M, Lyraraki E, Papadaki HΑ, Damilakis J. Probability of carcinogenesis due to involved field and involved site radiation therapy techniques for supra- and infradiaphragmatic Hodgkin's disease. Phys Med 2019; 57:100-106. [PMID: 30738513 DOI: 10.1016/j.ejmp.2018.12.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To estimate the second cancer risk associated with Hodgkin Lymphoma (HL) radiotherapy at supradiaphragmatic or infradiaphragmatic region, using the involved field (IFRT) and the involved site radiotherapy (ISRT). MATERIALS AND METHODS IFRT and ISRT treatment plans were created for twenty HL patients. Three dimensional plans (3DRT) were employed for all patients. The organ equivalent dose (OED) and lifetime attributable risk (LAR) for organs at risk were estimated with mechanistic, plateau and bell-shaped model. Estimated risk values were compared with nominal risk of unexposed population. RESULTS For supradiaphragmatic radiotherapy, the mean OED range was 0.63-8.53 Gy and 0.63-7.26 Gy for IFRT and ISRT, respectively. The corresponding range for infradiaphragmatic radiotherapy was 0.18-7.64 Gy and 0.80-4.95 Gy. The LAR for cancer induction in the partially in field organs at risk after IFRT was 0.5%-8.0% and 0.2%-9.3% at supradiaphragmatic and infradiaphragmatic regions, respectively. The corresponding risk after ISRT method was 0.5%-5.2% and 0.9%-6.0%. Estimated cancer risk for breast, lung, thyroid, colon and rectal with ISRT was found significantly reduced compared to IFRT. The risk of secondary malignancies for lung, mouth, pharynx, rectum and colon was assessed more than 1.2 times higher than nominal risk for IFRT. The respective risk using ISRT was above nominal only for pharyngeal cancer. CONCLUSION ISRT compared with IFRT, results in decreased second cancer risk in most organs considered. Second cancer probability with IFRT was higher than the nominal risk for certain organs, while for ISRT remains higher only for pharyngeal cancer.
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Affiliation(s)
- Kalliopi M Kourinou
- Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion 71003, Crete, Greece.
| | - Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion 71003, Crete, Greece
| | - Efrosini Lyraraki
- Department of Radiotherapy and Oncology, Heraklion University Hospital, Heraklion 71110, Crete, Greece
| | - Helen Α Papadaki
- Department of Hematology, Heraklion University Hospital, Heraklion 71110, Crete, Greece
| | - John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion 71003, Crete, Greece
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Demoor-Goldschmidt C, Supiot S, Mahé MA, Oberlin O, Allodji R, Haddy N, Helfre S, Vigneron C, Brillaud-Meflah V, Bernier V, Laprie A, Ducassou A, Claude L, Diallo I, de Vathaire F. Clinical and histological features of second breast cancers following radiotherapy for childhood and young adult malignancy. Br J Radiol 2018; 91:20170824. [PMID: 29493262 DOI: 10.1259/bjr.20170824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the characteristics of early second breast cancer (SBC) among survivors of childhood and young adult malignancy treated with irradiation. METHODS We conducted a multicenter retrospective study of women who presented with breast cancer aged 50 years or younger in nine French centers. RESULTS 121 patients and 141 SBC were analyzed (invasive = 130; non-invasive = 11). The mean age at first cancer diagnosis was 15 years and at initial SBC diagnosis was 38 years. Bilateral disease before the age of 51 years was diagnosed in 16% of the females. The majority of SBC were invasive carcinomas (92%). Among the invasive carcinomas, 39% had a histoprognostic score of III, 3.1% overexpressed HER2 and 29% were triple negative. The proportion of triple negative phenotype SBC was higher in patients older at first cancer diagnosis [RR = 1.2, 95% CI (1.1-1.3)]. 94% of triple negative SBCs developed in breast tissue which had received >20 Gy. CONCLUSION We found a high proportion of aggressive SBC following thoracic radiotherapy in childhood or early adulthood. Advances in knowledge: SBC screening is recommended by scientific societies for these child/young-adulthood cancer survivors in the same way as the one for high risk women because of constitutional mutations. Our results support these recommendations, not only because of a similar cumulative risk, but also because of the aggressive histological characteristics.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Stéphane Supiot
- 3 Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , Saint-Herblain , France
| | - Marc-André Mahé
- 3 Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , Saint-Herblain , France
| | - Odile Oberlin
- 4 Department of Pediatric Oncology, Institut Gustave Roussy , Villejuif , France
| | - Rodrigue Allodji
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Nadia Haddy
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Sylvie Helfre
- 5 Department of Radiotherapy, Institut Curie , Paris , France
| | - Céline Vigneron
- 6 Department of Radiotherapy, Centre Paul Strauss , Strasbourg , France
| | | | - Valérie Bernier
- 8 Department of Radiotherapy, Centre Alexis Vautrin , Nancy , France
| | | | | | | | - Ibrahim Diallo
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Florent de Vathaire
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
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6
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Radiation Therapy in Diffuse Large B-Cell Lymphoma. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_20-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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7
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Jackson MW, Rusthoven CG, Jones BL, Kamdar M, Rabinovitch R. Improved Survival With Radiation Therapy in Stage I-II Primary Mediastinal B Cell Lymphoma: A Surveillance, Epidemiology, and End Results Database Analysis. Int J Radiat Oncol Biol Phys 2015; 94:126-132. [PMID: 26547384 DOI: 10.1016/j.ijrobp.2015.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/31/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary mediastinal B cell lymphoma (PMBCL) is an uncommon lymphoma for which trials are few with small patient numbers. The role of radiation therapy (RT) after standard immunochemotherapy for early-stage disease has never been studied prospectively. We used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate PMBCL and the impact of RT on outcomes. METHODS AND MATERIALS We queried the SEER database for patients with stage I-II PMBCL diagnosed from 2001 to 2011. Retrievable data included age, gender, race (white/nonwhite), stage, extranodal disease, year of diagnosis, and use of RT as a component of definitive therapy. Kaplan-Meier overall survival (OS) estimates, univariate (UVA) log-rank and multivariate (MVA) Cox proportional hazards regression analyses were performed. RESULTS Two hundred fifty patients with stage I-II disease were identified, with a median follow-up time of 39 months (range, 3-125 months). The median age was 36 years (range, 18-89 years); 61% were female; 76% were white; 45% had stage I disease, 60% had extranodal disease, and 55% were given RT. The 5-year OS for the entire cohort was 86%. On UVA, OS was improved with RT (hazard ratio [HR] 0.446, P=.029) and decreased in association with nonwhite race (HR 2.70, P=.006). The 5-year OS was 79% (no RT) and 90% (RT). On MVA, white race and RT remained significantly associated with improved OS (P=.007 and .018, respectively). The use of RT decreased over time: 61% for the 67 patients whose disease was diagnosed from 2001 to 2005 and 53% in the 138 patients treated from 2006 to 2010. CONCLUSION This retrospective population-based analysis is the largest PMBCL dataset to date and demonstrates a significant survival benefit associated with RT. Nearly half of patients treated in the United States do not receive RT, and its use appears to be declining. In the absence of phase 3 data, the use of RT should be strongly considered for its survival benefit in early-stage disease.
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Affiliation(s)
- Matthew W Jackson
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Manali Kamdar
- Department of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Rachel Rabinovitch
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
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