Hematologic Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_43_2720 - Adverse Events and Patient Reported Outcomes from Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma in the Involved Site Era

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Adverse Events and Patient Reported Outcomes from Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma in the Involved Site Era
T. C. Mullikin1, S. C. Lester1, T. Witzig2, T. M. Habermann2, W. G. Rule3, T. B. Daniels4, B. J. Stish1, J. A. Martenson1, S. L. Stafford1, T. J. Whitaker1, and N. N. Laack II1; 1Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 2Division of Hematology, Mayo Clinic, Rochester, MN, 3Mayo Clinic, Phoenix, AZ, 4Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ

Purpose/Objective(s): To report prospectively collected physician-reported adverse events (AEs) and Patient Reported Outcomes (PRO) for patients treated with RT for lymphoma in the involved site radiotherapy (ISRT) era.

Materials/Methods: We included patients with Hodgkin (HL) and Non-Hodgkin lymphoma (NHL) treated with curative-intent RT at our institution between 2013 and 2017. Physician-reported AEs were prospectively assessed before, and immediately upon, completion of RT using CTCAE Version 4.0. Patients treated at the main sites within the hospital network were also enrolled on a prospective PRO registry to assess quality of life. For inclusion in this analysis, histologic confirmation of lymphoma, receipt of curative-intent external beam radiotherapy, and completion of baseline and posttreatment questionnaires were required. PRO assessment included the PROMIS Global 10-- an overall quality of life assessment-- and a lymphoma specific subset of the PRO-CTCA-- departmentally designed to assess symptom impact on daily living. Validated Global Physical Health (GPH) component and Global Mental Health (GMH) component T-scores were computed, where a T score of 50th percentile (SD 10) corresponds to a normal, healthy person in the USA.

Results: 152 patients (HL n=104, 68%; NHL n=48, 32%) met inclusion criteria. 70% were treated with photon RT and 30% with proton RT. Prior to RT, patients with HL received multiagent chemotherapy (77%), autologous stem cell transplant (13%), or no treatment (11%, NLPHL). Median RT dose was 30 Gy (range, 20-50). Prior to RT, patients with NHL received immunochemotherapy/chemotherapy (90%), autologous stem cell transplant (2%), or no treatment (8%). Median RT dose was 30.6 Gy (r, 30-44.4). Physician-reported AEs were documented for 130 (90.8%) patients. There were no grade 4 or 5 AEs. One (0.8%) grade 3 AE, an uncomplicated pulmonary embolism, occurred. There were 325 Grade I/II adverse events in 121 patients with the most common being fatigue (79, 24%), RT-related dermatitis (58, 18%), and esophagitis (49, 15%). 45 patients completed serial PROMIS 10 assessments sufficient for comparison. There was no change in the GPH or GMH domains during RT (median = 0, range -2.5 to 3.1). Forty-one patients completed serial PRO-CTCAE assessments. At RT completion, 4 (9.7%), 30 (73%), and 10 (24.3%) patients reported some interference with daily activities from coughing, fatigue, and shortness of breath respectively. When compared with baseline responses, 11 patients had worse fatigue during RT, 9 had improved fatigue, and 10 had no change; 3 patients had worse shortness of breath, 3 had improved shortness of breath, and 4 had no change.

Conclusion: Curative-intent RT for lymphoma in the ISRT era is well tolerated acutely with minimal early serious adverse events and, typically, no detectable quality of life deterioration.

Author Disclosure: T.C. Mullikin: Employee; Mayo Clinic. S.C. Lester: Employee; Mayo Clinic. T. Witzig: None. T.M. Habermann: None. T.B. Daniels: None. B.J. Stish: None. T.J. Whitaker: None. N.N. Laack: Research Grant; Bristol Myers Squibb, National Institutes of Health. Vice Chair, Bone Committee; Children's Oncology Group.

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