Leukemia/Lymphoma/Hematologic

PD 08 - Hematologic 1 - Poster Discussion

1064 - Prognostic Factors and Patterns of Failure in Advanced Stage Hodgkin Lymphoma Treated With Stanford V and Radiation Therapy

Monday, October 22
4:21 PM - 4:27 PM
Location: Room 217 A/B

Prognostic Factors and Patterns of Failure in Advanced Stage Hodgkin Lymphoma Treated With Stanford V and Radiation Therapy
E. J. Moding, R. H. Advani, S. A. Rosenberg, and R. T. Hoppe; Stanford University School of Medicine, Stanford, CA

Purpose/Objective(s): The importance of consolidative radiation therapy to bulky initial sites of disease and macroscopic splenic disease following Stanford V chemotherapy for advanced stage Hodgkin lymphoma (HL) is well-established, but the potential benefit of irradiation to non-bulky initial sites of disease and the effectiveness of Stanford V chemotherapy in controlling those sites have not been well documented. We aimed to review the long-term outcomes of these patients to identify prognostic factors and patterns of failure that could impact future treatment decisions.

Materials/Methods: Patients with stage III or IV HL treated from May 1989 through March 2012 with the Stanford V regimen at one institution were retrospectively analyzed. All patients received 12 weeks of chemotherapy followed by 36 Gy in 1.5-2 Gy fractions to initial sites of disease greater than or equal to 5 cm in maximal diameter and the entire spleen if initial macroscopic splenic disease was present. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. The association between the risk of treatment failure and histology, B symptoms, number of Ann Arbor sites, mediastinal mass ratio, erythrocyte sedimentation rate, and the International Prognostic Score (IPS) was investigated with univariable and multivariable Cox proportional hazards models.

Results: A total of 170 patients were analyzed with a median follow up of 13 years. OS and PFS were 91.2% and 78.9% at 10 years respectively. 32 patients (18.8%) developed refractory or relapsed disease with a median time to progression of 9 months. Only IPS greater than 2 was a significant predictor of disease progression on univariable (HR 3.63; 95% CI 1.72-7.68; P<0.001) and multivariable analyses (HR 3.17; 95% CI 1.50-7.11; P=0.003). 19 out of 27 relapses (70.4%) occurred outside of the radiation treatment field and 17 out of 27 relapses (63.0%) occurred at original sites of disease. However, only 11 of 170 patients (6.5%) relapsed exclusively at original, non-bulky sites of disease that per protocol were not treated with radiation therapy. The local control rate for non-bulky sites treated with chemotherapy alone was 96.1% and for bulky disease treated with consolidative irradiation following chemotherapy was 97.7%.

Conclusion: Patients with advanced stage HL treated with the Stanford V regimen had excellent long-term outcomes and low rates of relapse. Given the low frequency of isolated failures at non-bulky initial sites of disease, our results support the use of radiation limited to initially bulky sites of disease. In addition, these results raise the possibility that more selective use of radiation therapy based on imaging response may be a feasible approach.

Author Disclosure: E.J. Moding: None. S.A. Rosenberg: None. R.T. Hoppe: Employee; Stanford University. Honoraria; NCCN. Board Member; ISCL.

Everett Moding, MD, PhD

Disclosure:
No relationships to disclose.

Biography:
Everett Moding, MD, PhD, is a PGY-4 radiation oncology resident at Stanford University. He attended medical school at Duke University where he completed his PhD with Dr. David Kirsch. He is currently pursuing the Holman pathway in the laboratory of Dr. Maximilian Diehn where he is analyzing circulating tumor DNA levels during radiation therapy to monitor response to treatment and predict outcomes in patients with non-small cell lung cancer.

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