1
|
Withofs N, Bonnet C, Hustinx R. 2-deoxy-2-[ 18F]FDG PET Imaging for Therapy Assessment in Hodgkin's and Non-Hodgkin Lymphomas. PET Clin 2024:S1556-8598(24)00047-6. [PMID: 38945737 DOI: 10.1016/j.cpet.2024.05.001] [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: 07/02/2024]
Abstract
The 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography combined with computed tomography (PET/CT) has contributed to outcome improvement of patients with lymphoma. The use of [18F]FDG PET/CT for staging and response assessment is successfully applied both in routine clinical practice and in clinical trials. The challenges lie in enhancing the outcomes of lymphoma patients, particularly those with advanced or refractory/relapsed disease, and to minimize the long-term toxicity associated with treatments, including radiation therapy. The objective of this review article is to present contemporary data on the use of [18F]FDG PET/CT for treatment assessment of aggressive lymphomas.
Collapse
Affiliation(s)
- Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Quartier Hopital, Avenue de l'hopital 1, Liege, Belgium; GIGA-Nuclear Medicine Lab, University of Liege, CHU - B34 Quartier Hôpital, Avenue de l'Hôpital 11, Liège, BELGIQUE.
| | - Christophe Bonnet
- Department of Hematology, CHU of Liege, Quartier Hôpital, Avenue de l'hôpital 1, 4000 Liege 1, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Quartier Hopital, Avenue de l'hopital 1, Liege, Belgium; GIGA-Nuclear Medicine Lab, University of Liege, CHU - B34 Quartier Hôpital, Avenue de l'Hôpital 11, Liège, BELGIQUE
| |
Collapse
|
2
|
Kahn JM, Mauz-Korholz C, Hernandez T, Milgrom SA, Castellino SM. Pediatric and Adolescent Hodgkin Lymphoma: Paving the Way for Standards of Care and Shared Decision Making. Am Soc Clin Oncol Educ Book 2024; 44:e432420. [PMID: 38788179 DOI: 10.1200/edbk_432420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Hodgkin lymphoma (HL) is a treatable cancer with an incidence peak in adolescent and young adult years. Treatment strategies have been developed to balance the intensity of therapy needed to maintain disease-free survival while simultaneously preserving overall survival. Risk-based, response-adapted frontline therapy has long used a combination of chemotherapy and radiotherapy (RT). Successive clinical trials over the past three decades have safely reduced cumulative alkylator, anthracycline, and RT exposures for many patients. The advent of checkpoint inhibitors and the CD30-targeted antibody drug conjugate, brentuximab vedotin, has provided new options for de-escalation of conventional therapies associated with late effects in survivors treated at a young age. The ability to evaluate novel agents has been accelerated in collaborative trials inclusive of children and adolescents within the US National Clinical Trials Network and between the Children's Oncology Group and the EuroNet Pediatric Hodgkin Lymphoma Consortium. With numerous treatment options, patients with HL and their clinicians have an opportunity for shared decision making from diagnosis, through cancer treatment, and into survivorship. Given excellent survival outcomes, decisions about treatment in classic HL should be collaborative and attention to long-term survivorship needs should remain a high priority. Patient-reported outcomes remain an important tool to aid clinicians working with survivors to optimize health status and related quality of life for decades after HL therapy.
Collapse
Affiliation(s)
- Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, NY
| | - Christine Mauz-Korholz
- Justus-Liebig University of Giessen, Giessen, and Medical Faculty of the Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Tricia Hernandez
- Department of Education & Services, The Leukemia & Lymphoma Society, Rye Brook, NY
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| |
Collapse
|
3
|
Heneghan MB, Belsky JA, Milgrom SA, Forlenza CJ. The pediatric approach to Hodgkin lymphoma. Semin Hematol 2024:S0037-1963(24)00061-1. [PMID: 38851951 DOI: 10.1053/j.seminhematol.2024.05.003] [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: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024]
Abstract
Hodgkin lymphoma (HL) occurs throughout the lifespan but is one of the most common cancers in adolescents and young adults (AYA; 15-39 years). HL has become a highly curable disease with survival rates surpassing 90%, including patients with high-risk and advanced stage disease. Unfortunately, intensive treatment carries a risk of short- and long-term toxicity. Given the decades pediatric HL survivors are expected to live after treatment, the pediatric approach to treatment has focused on improving the therapeutic index through response adapted treatment and more recently the incorporation of novel agents. The efforts of pediatric and medical oncologists in research and clinical trial development have long occurred in parallel, but recent efforts have laid the foundation for collaboration with the goal of standardizing AYA care and allowing earlier incorporation of novel therapy for younger patients. This review focuses on the evolution of the management of pediatric HL including epidemiology, biology, and approaches to upfront and salvage treatment regimens.
Collapse
Affiliation(s)
- Mallorie B Heneghan
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah/Primary Children's Hospital, Salt Lake City, UT.
| | - Jennifer A Belsky
- Department of Pediatrics, Riley Hospital for Children/Indiana University School of Medicine, Indianapolis, IN
| | - Sarah A Milgrom
- Department or Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | | |
Collapse
|
4
|
Leger KJ, Narayan HK. Progress Toward Cardiac Risk Reduction With the Evolution of Pediatric Hodgkin Lymphoma Therapy. JAMA Netw Open 2024; 7:e2350999. [PMID: 38241051 DOI: 10.1001/jamanetworkopen.2023.50999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Affiliation(s)
- Kasey J Leger
- Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, University of Washington, Seattle
| | - Hari K Narayan
- Department of Pediatrics, University of California, San Diego
- Rady Children's Hospital San Diego, San Diego, California
| |
Collapse
|
5
|
Keller FG, Kahl B, Friedberg JW. Current directions in the treatment of classical Hodgkin lymphoma. EJHAEM 2023; 4:908-911. [PMID: 38024613 PMCID: PMC10660392 DOI: 10.1002/jha2.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 12/01/2023]
Abstract
Optimal management of patients who present with Hodgkin lymphoma continues to evolve. Most patients are cured with current treatment strategies, some but both short and long-term morbidity and mortality from treatment have particular relevance given the youth of the patient population. Combininations of targeted agents together with conventional chemotherapy have recently been investigated in phase 3 cliniial trials for advanced-stage Hodkgkin lymphoma, and have demonstrated improved efficacy compared with chemotherapy alone. These include both antibody-drug conjugates and PD-1 blockade. Treatment approaches have historically differed between pediatric and adult groups, but recent collaborations between adullt and pediatric groups via the NCTN mechanism have resulted in the successful completion of enrollment in an advanced-stage Hodgkin lymphoma and the opening of an early-stage trial that will enroll patients accross a broad age spectrum. Novel approachs incorporating targeted and immunomodulatory agents in the relapse setting are being actively investagated in the relapse setting as well.
Collapse
Affiliation(s)
- Frank G. Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaEmory University School of MedicineAtlantaGeorgiaUSA
| | - Brad Kahl
- Departemnt of Medicine, Division of OncologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jonathan W. Friedberg
- Wilmot Cancer Institute, Departent of MedicineUniversity of Rochester School of MedicineRochesterNew YorkUSA
| |
Collapse
|
6
|
Akshintala S, Sundby RT, Bernstein D, Glod JW, Kaplan RN, Yohe ME, Gross AM, Derdak J, Lei H, Pan A, Dombi E, Palacio-Yance I, Herrera KR, Miettinen MM, Chen HX, Steinberg SM, Helman LJ, Mascarenhas L, Widemann BC, Navid F, Shern JF, Heske CM. Phase I trial of Ganitumab plus Dasatinib to Cotarget the Insulin-Like Growth Factor 1 Receptor and Src Family Kinase YES in Rhabdomyosarcoma. Clin Cancer Res 2023; 29:3329-3339. [PMID: 37398992 PMCID: PMC10529967 DOI: 10.1158/1078-0432.ccr-23-0709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/05/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Antibodies against insulin-like growth factor (IGF) type 1 receptor have shown meaningful but transient tumor responses in patients with rhabdomyosarcoma (RMS). The SRC family member YES has been shown to mediate IGF type 1 receptor (IGF-1R) antibody acquired resistance, and cotargeting IGF-1R and YES resulted in sustained responses in murine RMS models. We conducted a phase I trial of the anti-IGF-1R antibody ganitumab combined with dasatinib, a multi-kinase inhibitor targeting YES, in patients with RMS (NCT03041701). PATIENTS AND METHODS Patients with relapsed/refractory alveolar or embryonal RMS and measurable disease were eligible. All patients received ganitumab 18 mg/kg intravenously every 2 weeks. Dasatinib dose was 60 mg/m2/dose (max 100 mg) oral once daily [dose level (DL)1] or 60 mg/m2/dose (max 70 mg) twice daily (DL2). A 3+3 dose escalation design was used, and maximum tolerated dose (MTD) was determined on the basis of cycle 1 dose-limiting toxicities (DLT). RESULTS Thirteen eligible patients, median age 18 years (range 8-29) enrolled. Median number of prior systemic therapies was 3; all had received prior radiation. Of 11 toxicity-evaluable patients, 1/6 had a DLT at DL1 (diarrhea) and 2/5 had a DLT at DL2 (pneumonitis, hematuria) confirming DL1 as MTD. Of nine response-evaluable patients, one had a confirmed partial response for four cycles, and one had stable disease for six cycles. Genomic studies from cell-free DNA correlated with disease response. CONCLUSIONS The combination of dasatinib 60 mg/m2/dose daily and ganitumab 18 mg/kg every 2 weeks was safe and tolerable. This combination had a disease control rate of 22% at 5 months.
Collapse
Affiliation(s)
- Srivandana Akshintala
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - R. Taylor Sundby
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Donna Bernstein
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - John W. Glod
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Rosandra N. Kaplan
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Marielle E. Yohe
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
- Laboratory of Cell and Developmental Signaling, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, Maryland
| | - Andrea M. Gross
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Joanne Derdak
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Haiyan Lei
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Alexander Pan
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Isabel Palacio-Yance
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Kailey R. Herrera
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Markku M. Miettinen
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Helen X. Chen
- Cancer Therapy Evaluation Program (CTEP), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Seth M. Steinberg
- Biostatistics and Data Management, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Lee J. Helman
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles (CHLA), Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- The Osteosarcoma Institute, Dallas, Texas
| | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles (CHLA), Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brigitte C. Widemann
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Fariba Navid
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles (CHLA), Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jack F. Shern
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Christine M. Heske
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| |
Collapse
|
7
|
Castellino SM, Giulino-Roth L, Harker-Murray P, Kahn J, Forlenza C, Cho S, Hoppe B, Parsons SK, Kelly KM. Children's Oncology Group's 2023 blueprint for research: Hodgkin lymphoma. Pediatr Blood Cancer 2023; 70 Suppl 6:e30580. [PMID: 37505794 PMCID: PMC10660893 DOI: 10.1002/pbc.30580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
Abstract
The goal of therapy in pediatric Hodgkin lymphoma (HL) is to maximize overall survival while minimizing the morbidity of curative therapy. Key findings from recent Children's Oncology Group (COG) trials include: (i) superior event-free survival with the addition of brentuximab vedotin (Bv) in frontline regimens for high-risk disease, (ii) successful reduction in myeloablative regimens with demonstrated safety and efficacy of Bv and checkpoint inhibitor therapy in relapsed disease, and (ii) the potential to select a population that can be salvaged after relapse without receiving a stem cell transplant. The COG HL committee will lead a National cancer Institute National Clinical Trials Network phase 3 trial to evaluate the combination of Bv/nivolumab in early-stage disease. Ongoing advances in technology and blood biomarkers are increasing the ability to deliver biologically driven, personalized treatment for HL.
Collapse
Affiliation(s)
- Sharon M. Castellino
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta/ Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | | | - Justine Kahn
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | | | - Steve Cho
- Department of Radiology, University of Wisconsin/ University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI
| | - Bradford Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Susan K. Parsons
- Department of Medicine, Tufts University School of Medicine/ Department of Pediatrics, Tufts University School of Medicine/ Institute for Clinical Research and Health Policy Studies, Reid R. Sacco AYA Cancer Program/ Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center/ Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| |
Collapse
|
8
|
Dixon SB, Liu Q, Chow EJ, Oeffinger KC, Nathan PC, Howell RM, Leisenring WM, Ehrhardt MJ, Ness KK, Krull KR, Mertens AC, Hudson MM, Robison LL, Yasui Y, Armstrong GT. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet 2023; 401:1447-1457. [PMID: 37030315 PMCID: PMC10149583 DOI: 10.1016/s0140-6736(22)02471-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND 5-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond 5-years (late mortality) related to cancer and cancer treatment. Specific causes of health-related (non-recurrence, non-external) late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors are not well described. Through using a well-characterised cohort of 5-year survivors of the most common childhood cancers, we evaluated specific health-related causes of late mortality and excess deaths compared with the general US population and identified targets to reduce future risk. METHODS In this multi-institutional, hospital-based, retrospective cohort study, late mortality (death ≥5 years from diagnosis) and specific causes of death were evaluated in 34 230 5-year survivors of childhood cancer diagnosed at an age younger than 21 years from 1970 to 1999 at 31 institutions in the USA and Canada; median follow-up from diagnosis was 29 years (range 5-48) in the Childhood Cancer Survivor Study. Demographic, self-reported modifiable lifestyle (ie, smoking, alcohol, physical activity, and BMI) and cardiovascular risk factors (ie, hypertension, diabetes, and dyslipidaemia) associated with health-related mortality (which excludes death from primary cancer and external causes and includes death from late effects of cancer therapy) were evaluated. FINDINGS 40-year cumulative all-cause mortality was 23·3% (95% CI 22·7-24·0), with 3061 (51·2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111-163), including those due to the top three causes of health-related death in the general population: cancer (absolute excess risk per 10 000 person-years 54, 95% CI 41-68), heart disease (27, 18-38), and cerebrovascular disease (10, 5-17). Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20-30% reduction in health-related mortality independent of other factors (all p values ≤0·002). INTERPRETATION Survivors of childhood cancer are at excess risk of late mortality even 40 years from diagnosis, due to many of the leading causes of death in the US population. Modifiable lifestyle and cardiovascular risk factors associated with reduced risk for late mortality should be part of future interventions. FUNDING US National Cancer Institute and the American Lebanese Syrian Associated Charities.
Collapse
Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Eric J Chow
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Paul C Nathan
- Division of Hematology and Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rebecca M Howell
- Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy M Leisenring
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
9
|
Galunic Bilic L, Santek F, Grah JJ, Basic-Kinda S, Mandac Smoljanovic I, Ostojic Kolonic S, Mitrovic Z, Vodanovic M, Dujmovic D, Aurer I. Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients: a single-centre experience. LA RADIOLOGIA MEDICA 2023; 128:492-500. [PMID: 36920724 DOI: 10.1007/s11547-023-01615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Data on efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients are scarce. We therefore performed this retrospective study to analyse our experience with radiotherapy exclusively to infradiaphragmal fields. MATERIALS AND METHODS we retrospectively evaluated 101 patients treated between 2003 and 2014. Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy. RESULTS After a median follow-up of 66 months (range 1-211 months), we observed lymphoma recurrence in 38 patients (38%), five in the RT field and 33 out-of-field. Recurrences were significantly more frequent in the salvage group (17 out-of-field and 4 in-field in 31 patients) than in adjuvant group (16 out-of-field and 1 in-field in 70 patients; p < 0.001). The 2-, 5- and 10-year event-free survival (EFS) rates were 62%, 56% and 54%. The 2-, 5- and 10-year overall survival (OS) rates for the entire group of patients are 73%, 60% and 54%, respectively. Acute side effects occurred in 43 (43%) patients, most frequent gastrointestinal in 26 (26%) patients. Late side effects occurred in 12 (12%) of all patients, 6 of 23 (26%) followed up for more than 10 years. Six patients developed secondary cancers, four gastrointestinal disturbances, two diabetes mellitus and three renal failure. CONCLUSION Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy. However, patients should be monitored for a secondary malignancy.
Collapse
Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Josip J Grah
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- Department for Radiotherapy, Univ. Klinik Für Strahlentherapie-Radioonkologie- LKH Graz, Graz, Austria
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Igor Aurer
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
10
|
Levis M, Campbell BA, Matrone F, Grapulin L, Di Russo A, Buglione M, Iamundo De Cumis I, Simontacchi G, Ciammella P, Magli A, Pascale G, Meregalli S, MacManus M, Fanetti G, De Felice F, Furfaro G, Ciccone G, Ricardi U. Peritransplant Radiation Therapy in Patients With Refractory or Relapsed Hodgkin Lymphoma Undergoing Autologous Stem Cell Transplant: Long-Term Results of a Retrospective Study of the Fondazione Italiana Linfomi. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00165-7. [PMID: 36822373 DOI: 10.1016/j.ijrobp.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE In this multicenter collaboration, we report real-world data in the largest published series of long-term outcomes for patients with relapsed/refractory (r/r) Hodgkin lymphoma (HL) treated with peritransplant radiation therapy (pt-RT) and high-dose chemotherapy with autologous stem cell transplant (ASCT). METHODS AND MATERIALS We conducted a retrospective analysis including data from 12 institutions. Eligibility required histologic diagnosis of HL, receipt of ASCT plus pt-RT between 2004 and 2014 for r/r HL, and age ≥18 years at the time of ASCT. All patients received salvage chemotherapy for maximum debulking before ASCT. Metabolic responses were scored according to the Lugano Classification. The primary endpoint was overall survival (OS). Univariate and multivariate Cox proportional hazards were calculated to estimate the effect of covariates on patients' outcome. RESULTS One hundred thirty-one patients were eligible: 68 were male (52%), and median age at ASCT was 32 years (range, 18-70). At the time of diagnosis with r/r HL, 92 patients (70%) had limited (stage I-II) disease, and 10 patients (8%) had bulky disease. Pt-RT was given pre-ASCT in 32 patients (24%) and post-ASCT in 99 (76%); median prescribed dose was 30.6 Gy (range, 20-44 Gy). With median follow-up of 60 months, 3- and 5-year OS were 84% and 77%, while 3- and 5-year progression-free survival were 75% and 72%, respectively. On univariate and multivariate analysis, advanced stage at relapse (hazard ratio [HR], 2.18; P = .04), irradiation of >3 sites (HR, 3.69; P = .01), and incomplete metabolic response after salvage chemotherapy (HR, 2.24; P = .01) had a negative effect on OS. The sequencing of pt-RT (pre- vs post-ASCT) did not affect outcomes. CONCLUSIONS Overall, the addition of pt-RT to ASCT for patients with r/r HL is associated with very good outcomes. Limited relapsed disease with ≤3 sites involved and achievement of complete metabolic response after salvage chemotherapy were predictive of more favorable prognosis.
Collapse
Affiliation(s)
- Mario Levis
- Department of Oncology, University of Torino, Torino, Italy.
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Fabio Matrone
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano, Centro di Riferimento Oncologico-Istituto di Ricovero e Cura a Carattere Scientifico (CRO-IRCCS), Aviano, Italy
| | - Lavinia Grapulin
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Anna Di Russo
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Michela Buglione
- Department of Radiation Oncology, University and Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Ilenia Iamundo De Cumis
- Department of Radiation Oncology, Oncology Hospital A. Businco, ARNAS G. Brotzu, Cagliari, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Magli
- Department of Radiation Oncology, University Hospital of Udine, Udine, Italy
| | - Giuliana Pascale
- Radiotherapy Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Sofia Meregalli
- Radiotherapy Unit, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Giuseppe Fanetti
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano, Centro di Riferimento Oncologico-Istituto di Ricovero e Cura a Carattere Scientifico (CRO-IRCCS), Aviano, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovannino Ciccone
- Clinical Epidemiology, Città della Salute e della Scienza and Centro Prevenzione Oncologica (CPO) Piemonte, Torino, Italy
| | | |
Collapse
|
11
|
Bottinor W. Mitigating, monitoring, and managing long-term chemotherapy- and radiation-induced cardiac toxicity. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:251-258. [PMID: 36485088 PMCID: PMC9820865 DOI: 10.1182/hematology.2022000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Five-year survival for childhood cancer now exceeds 85%. However, for many patients, treatment requires the use of intensive anthracycline-based chemotherapy and radiotherapy, both of which are associated with significant long-term cardiovascular toxicity. As such, late cardiovascular disease is now one of the leading causes of premature morbidity and mortality among childhood cancer survivors. Recent advances over the past decade have refined the cardiotoxic potential of various chemotherapeutics, and ongoing work seeks to determine the efficacy of various cardioprotective strategies in children receiving active cancer therapy. The development of risk prediction models offers an additional strategy to define risk for both newly treated and long-term survivors. Current screening strategies are primarily based on echocardiography, although there is active research investigating methods to further optimize screening through myocardial strain, cardiac magnetic resonance imaging, blood biomarkers, and genetics, along with the cost-effectiveness of different screening strategies. Active research is also underway investigating the efficacy of prevention strategies for childhood cancer survivors who have completed cancer therapy. This ranges from the use of medications to mitigate potential pathologic ventricular remodeling to reducing adverse and modifiable cardiovascular risk factors (eg, hypertension, dyslipidemia, insulin resistance, physical inactivity, tobacco exposure), many of which may be more common in cancer survivors vs the general population and are often underrecognized and undertreated in relatively young adult-aged survivors of childhood cancer.
Collapse
|
12
|
Alabdaljabar MS, Durani U, Thompson CA, Constine LS, Hashmi SK. The forgotten survivor: A comprehensive review on Non-Hodgkin lymphoma survivorship. Am J Hematol 2022; 97:1627-1637. [PMID: 36069675 DOI: 10.1002/ajh.26719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 01/31/2023]
Abstract
The number of non-Hodgkin lymphoma (NHL) survivors is increasing. With the advancement of NHL therapies, it is crucial to focus on the challenges these survivors may face. Three main categories are to be considered in NHL survivorship, including quality of life and uncertainty about the future, possible physical health complications (including cardiovascular disease, infertility, and subsequent neoplasms), and the impact of novel NHL treatments and their potential complications. The latter includes CAR T-cell therapy, monoclonal antibodies, checkpoint inhibitors, and hematopoietic stem cell transplantation. In this report, we aim to shed the light on these aspects and to discuss survivorship care plan for NHL.
Collapse
Affiliation(s)
| | - Urshila Durani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie A Thompson
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, New York City, New York, USA
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Sheikh Shakhbout Medical City / Mayo Clinic, Abu Dhabi, United Arab Emirates
| |
Collapse
|
13
|
Castellino SM, Pei Q, Parsons SK, Hodgson D, McCarten K, Horton T, Cho S, Wu Y, Punnett A, Dave H, Henderson TO, Hoppe BS, Charpentier AM, Keller FG, Kelly KM. Brentuximab Vedotin with Chemotherapy in Pediatric High-Risk Hodgkin's Lymphoma. N Engl J Med 2022; 387:1649-1660. [PMID: 36322844 PMCID: PMC9945772 DOI: 10.1056/nejmoa2206660] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In adults with advanced-stage Hodgkin's lymphoma, the CD30-directed antibody-drug conjugate brentuximab vedotin combined with multiagent chemotherapy has been shown to have greater efficacy, but also more toxic effects, than chemotherapy alone. The efficacy of this targeted therapy approach in children and adolescents with Hodgkin's lymphoma is unclear. METHODS We conducted an open-label, multicenter, randomized, phase 3 trial involving patients 2 to 21 years of age with previously untreated Hodgkin's lymphoma of stage IIB with bulk tumor or stage IIIB, IVA, or IVB. Patients were assigned to receive five 21-day cycles of brentuximab vedotin with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide (brentuximab vedotin group) or the standard pediatric regimen of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (standard-care group). Slow-responding lesions, defined by a score of 4 or 5 (on a 5-point scale, with scores of 1 to 3 indicating rapid-responding lesions), were identified on centrally reviewed positron-emission tomography-computed tomography after two cycles. Involved-site radiation therapy was administered after the fifth cycle of therapy to slow-responding lesions and to large mediastinal adenopathy that was present at diagnosis. The primary end point was event-free survival, defined as the time until disease progression occurred, relapse occurred, a second malignant neoplasm developed, or the patient died. Safety and overall survival were assessed. RESULTS Of 600 patients who were enrolled across 153 institutions, 587 were eligible. At a median follow-up of 42.1 months (range, 0.1 to 80.9), the 3-year event-free survival was 92.1% (95% confidence interval [CI], 88.4 to 94.7) in the brentuximab vedotin group, as compared with 82.5% (95% CI, 77.4 to 86.5) in the standard-care group (hazard ratio for event or death, 0.41; 95% CI, 0.25 to 0.67; P<0.001). The percentage of patients who received involved-site radiation therapy did not differ substantially between the brentuximab vedotin group and the standard-care group (53.4% and 56.8%, respectively). Toxic effects were similar in the two groups. Overall survival at 3 years was 99.3% (95% CI, 97.3 to 99.8) in the brentuximab vedotin group and 98.5% (95% CI, 96.0 to 99.4) in the standard-care group. CONCLUSIONS The addition of brentuximab vedotin to standard chemotherapy resulted in superior efficacy, with a 59% lower risk of an event or death, and no increase in the incidence of toxic effects at 3 years. (Funded by the National Institutes of Health and others; AHOD1331 ClinicalTrials.gov number, NCT02166463.).
Collapse
Affiliation(s)
- Sharon M Castellino
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Qinglin Pei
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Susan K Parsons
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - David Hodgson
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Kathleen McCarten
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Terzah Horton
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Steve Cho
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Yue Wu
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Angela Punnett
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Hema Dave
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Tara O Henderson
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Bradford S Hoppe
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Anne-Marie Charpentier
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Frank G Keller
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Kara M Kelly
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| |
Collapse
|
14
|
Henderson TO, Liu Q, Turcotte LM, Neglia JP, Leisenring W, Hodgson D, Diller L, Kenney L, Morton L, Berrington de Gonzalez A, Arnold M, Bhatia S, Howell RM, Smith SA, Robison LL, Armstrong GT, Oeffinger KC, Yasui Y, Moskowitz CS. Association of Changes in Cancer Therapy Over 3 Decades With Risk of Subsequent Breast Cancer Among Female Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study (CCSS). JAMA Oncol 2022; 8:2797487. [PMID: 36227603 PMCID: PMC9562103 DOI: 10.1001/jamaoncol.2022.4649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Importance Breast cancer is the most common invasive subsequent malignant disease in childhood cancer survivors, though limited data exist on changes in breast cancer rates as primary cancer treatments have evolved. Objective To quantify the association between temporal changes in cancer treatment over 3 decades and subsequent breast cancer risk. Design, Setting, and Participants Retrospective cohort study of 5-year cancer survivors diagnosed when younger than 21 years between 1970 and 1999, with follow-up through December 5, 2020. Exposures Radiation and chemotherapy dose changes over time. Main Outcomes and Measures Breast cancer cumulative incidence rates and age-specific standardized incidence ratios (SIRs) compared across treatment decades (1970-1999). Piecewise exponential models estimated invasive breast cancer and ductal carcinoma in situ (DCIS) risk and associations with treatment exposures, adjusted for age at childhood cancer diagnosis and attained age. Results Among 11 550 female survivors (median age, 34.2 years; range 5.6-66.8 years), 489 developed 583 breast cancers: 427 invasive, 156 DCIS. Cumulative incidence was 8.1% (95% CI, 7.3%-9.0%) by age 45 years. An increased breast cancer risk (SIR, 6.6; 95% CI, 6.1-7.2) was observed for survivors compared with the age-sex-calendar-year-matched general population. Changes in therapy by decade included reduced rates of chest (34% in the 1970s, 22% in the 1980s, and 17% in the 1990s) and pelvic radiotherapy (26%, 17%, and 13% respectively) and increased rates of anthracycline chemotherapy exposures (30%, 51%, and 64%, respectively). Adjusting for age and age at diagnosis, the invasive breast cancer rate decreased 18% every 5 years of primary cancer diagnosis era (rate ratio [RR], 0.82; 95% CI, 0.74-0.90). When accounting for chest radiotherapy exposure, the decline attenuated to an 11% decrease every 5 years (RR, 0.89; 95% CI, 0.81-0.99). When additionally adjusted for anthracycline dose and pelvic radiotherapy, the decline every 5 years increased to 14% (RR, 0.86; 95% CI, 0.77-0.96). Although SIRs of DCIS generally increased over time, there were no statistically significant changes in incidence. Conclusions and Relevance Invasive breast cancer rates in childhood cancer survivors have declined with time, especially in those younger than 40 years. This appears largely associated with the reduced use of chest radiation therapy, but was tempered by concurrent changes in other therapies.
Collapse
Affiliation(s)
| | - Qi Liu
- University of Alberta, Alberta, Canada
| | | | | | | | | | - Lisa Diller
- Dana-Farber Cancer Institute/Children’s Hospital Boston, Boston, Massachusetts
| | - Lisa Kenney
- Dana-Farber Cancer Institute/Children’s Hospital Boston, Boston, Massachusetts
| | | | | | - Michael Arnold
- Children’s Hospital of Colorado, Denver, Colorado
- University of Colorado, Anschutz Medical Campus, Aurora
| | | | | | | | | | | | | | - Yutaka Yasui
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | |
Collapse
|
15
|
Williams AM, Mirzaei Salehabadi S, Xing M, Phillips NS, Ehrhardt MJ, Howell R, Yasui Y, Oeffinger KC, Gibson T, Chow EJ, Leisenring W, Srivastava D, Hudson MM, Robison LL, Armstrong GT, Krull KR. Modifiable risk factors for neurocognitive and psychosocial problems after Hodgkin lymphoma. Blood 2022; 139:3073-3086. [PMID: 34861035 PMCID: PMC9121843 DOI: 10.1182/blood.2021013167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Long-term survivors of childhood Hodgkin lymphoma (HL) experience a high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. A total of 1760 survivors of HL (mean ± SD age, 37.5 ± 6.0 years; time since diagnosis, 23.6 ± 4.7 years; 52.1% female) and 3180 siblings (mean age, 33.2 ± 8.5 years; 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.3 (1 = mild, 2 = moderate, 3 = severe/disabling, and 4 = life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment, and grade 2 or higher chronic health conditions. Compared with siblings, survivors had significantly higher risk (all, P < .05) of neurocognitive impairment (eg, memory, 8.1% vs 5.7%), anxiety (7.0% vs 5.4%), depression (9.1% vs 7%), unemployment (9.6% vs 4.4%), and impaired physical/mental quality of life (eg, physical function, 11.2% vs 3.0%). Smoking was associated with a higher risk of impairment in task efficiency (RR, 1.56; 95% confidence interval [CI], 1.02-2.39), emotional regulation (RR, 1.84; 95% CI, 1.35-2.49), anxiety (RR, 2.43; 95% CI, 1.51-3.93), and depression (RR, 2.73; 95% CI, 1.85-4.04). Meeting the exercise guidelines of the Centers for Disease Control and Prevention was associated with a lower risk of impairment in task efficiency (RR, 0.70; 95% CI, 0.52-0.95), organization (RR, 0.60; 95% CI, 0.45-0.80), depression (RR, 0.66; 95% CI, 0.48-0.92), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rebecca Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kevin C Oeffinger
- Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC
| | - Todd Gibson
- Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, Rockville, MD
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | - Wendy Leisenring
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | | | - Melissa M Hudson
- Department of Epidemiology and Cancer Control
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Kevin R Krull
- Department of Epidemiology and Cancer Control
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW Liquid biopsies have emerged as a noninvasive alternative to tissue biopsy with potential applications during all stages of pediatric oncology care. The purpose of this review is to provide a survey of pediatric cell-free DNA (cfDNA) studies, illustrate their potential applications in pediatric oncology, and to discuss technological challenges and approaches to overcome these hurdles. RECENT FINDINGS Recent literature has demonstrated liquid biopsies' ability to inform treatment selection at diagnosis, monitor clonal evolution during treatment, sensitively detect minimum residual disease following local control, and provide sensitive posttherapy surveillance. Advantages include reduced procedural anesthesia, molecular profiling unbiased by tissue heterogeneity, and ability to track clonal evolution. Challenges to wider implementation in pediatric oncology, however, include blood volume restrictions and relatively low mutational burden in childhood cancers. Multiomic approaches address challenges presented by low-mutational burden, and novel bioinformatic analyses allow a single assay to yield increasing amounts of information, reducing blood volume requirements. SUMMARY Liquid biopsies hold tremendous promise in pediatric oncology, enabling noninvasive serial surveillance with adaptive care. Already integrated into adult care, recent advances in technologies and bioinformatics have improved applicability to the pediatric cancer landscape.
Collapse
Affiliation(s)
- R Taylor Sundby
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | |
Collapse
|
17
|
Milgrom SA, Bakst RL, Campbell BA. Clinical Outcomes Confirm Conjecture: Modern Radiation Therapy Reduces the Risk of Late Toxicity in Survivors of Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2021; 111:841-850. [PMID: 34655558 DOI: 10.1016/j.ijrobp.2021.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah A Milgrom
- University of Colorado, Department of Radiation Oncology, Aurora, Colorado.
| | - Richard L Bakst
- Mount Sinai Hospital, Department of Radiation Oncology, New York, New York
| | - Belinda A Campbell
- Peter MacCallum Cancer Centre, Department of Radiation Oncology, Melbourne, Victoria, Australia; University of Melbourne, Department of Clinical Pathology, Parkville, Victoria, Australia; University of Melbourne, The Sir Peter MacCallum Department of Oncology, Parkville, Victoria, Australia
| |
Collapse
|
18
|
Hoppe BS, Advani R, Milgrom SA, Bakst RL, Ballas LK, Dabaja BS, Flowers CR, Ha CS, Mansur DB, Metzger ML, Pinnix CC, Plastaras JP, Roberts KB, Smith SM, Terezakis SA, Kirwan JM, Constine LS. Primary Mediastinal B Cell Lymphoma in the Positron-Emission Tomography Era Executive Summary of the American Radium Society Appropriate Use Criteria. Int J Radiat Oncol Biol Phys 2021; 111:36-44. [PMID: 33774076 DOI: 10.1016/j.ijrobp.2021.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Primary mediastinal B cell lymphoma (PMBCL) is a highly curable subtype of non-Hodgkin lymphoma that is diagnosed predominantly in adolescents and young adults. Consequently, long-term treatment-related morbidity is critical to consider when devising treatment strategies that include different chemoimmunotherapy strategies with or without radiation therapy. Furthermore, adaptive approaches using the end-of-chemotherapy (EOC) positron emission tomography (PET)/computed tomography (CT) scanning may help to determine which patients may benefit from additional therapies. We aimed to develop evidence-based guidelines for treating these patients. METHODS AND MATERIALS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database. The ARS expert committee, composed of radiation oncologists, hematologists, and pediatric oncologists, developed consensus guidelines using the modified Delphi framework. RESULTS Nine studies met the full criteria for inclusion based on reporting outcomes on patients with primary mediastinal B cell lymphoma with EOC PET/CT response scored with the 5-point Deauville scale. These studies formed the evidence for these guidelines in managing patients with PMBCL according to the EOC PET response, including after a 5-point Deauville scale of 1 to 3, 4, or 5, and for patients with relapsed and refractory disease. The expert group also developed guidance on radiation simulation, treatment planning, and plan evaluation based on expert opinion. CONCLUSIONS Various treatment approaches exist in the management of PMBCL, including different chemoimmunotherapy regimens, the use of consolidative radiation therapy, and adaptive approaches based on EOC PET/CT response. These guidelines can be used by practitioners to provide appropriate treatment according to different disease scenarios.
Collapse
Affiliation(s)
- Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
| | - Ranjana Advani
- Department of Radiation Oncology, Stanford Cancer Center, Palo Alto, California
| | - Sarah A Milgrom
- Department of Radiation Oncology,University of Colorado, Aurora, Colorado
| | - Richard L Bakst
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Leslie K Ballas
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher R Flowers
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chul S Ha
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - David B Mansur
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Monika L Metzger
- Department of Oncology, St Jude Children's Research Hospital and University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Chelsea C Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Kenneth B Roberts
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Jessica M Kirwan
- Department of Radiation Oncology, University of Florida Department of Radiation Oncology, Gainesville, Florida
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|