M. Oertel1, J. Kriz1, A. Kerkhoff2, J. Reusch2, K. Kröger1, K. Elsayad1, U. Haverkamp1, G. Lenz2, H. T. Eich1
1 Department of Radiation Oncology, University of Muenster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany, 2 Department of Medicine, Hematology and Oncology, University of Muenster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
Introduction: The optimal management of Hodgkin Lymphoma (HL) in the relapsed/recurrent (r/r) situation remains controversial. The purpose of this study is to identify relapse patterns and to investigate the role of radiation therapy (RT) for local control.
Material & Methods: A search of our institution database identified 19 r/r HL patients treated with RT in the primary and/or recurrent situation in the last 15 years (y), of which 14 (13 males, 1 female) were analyzed retrospectively.
Results: Median age at initial diagnosis was 28.9 years. Initial Ann-Arbor stage was I (1), II (6), III (3) or IV (3; 1 unknown), with B-symptoms in 5 patients. RT was applied in 9 patients, mostly as involved-field (IF) RT, with a median dose of 30 Gy (20–40 Gy). Recurrence was diagnosed after a median time of 1.8 y (0.6–11.8 y; 2 year recurrence-free survival: 42.9%) at a median age of 30.5 y (18.0–69.4 y) and was found infield (or in the former disease area) in 2 patients, out-of-field in 4 patients and as a combined pattern in 8 patients. For patients with RT in primary treatment, relapse distribution, was 1,3 and 5 for infield-, out-of-field- and combined relapses relapses; while for patients without RT it was 1,1 and 3 for the mentioned categories. RT in the primary treatment prolonged time to recurrence significantly (median: 4 y vs. 1.3 y; p = 0.042). For recurrent disease, RT was utilized in 7 cases with a median dose 30.6 Gy (19.8–36 Gy) as IF-RT in 5 cases, extended field (EF) RT in 1 case and consolidating RT in 2 cases. Second relapse occurred in 8 patients after 1.9 y (0.3–11.6 y; 2 year recurrence-free survival: 50%) after primary recurrence, with recurrences in previous areas in 1 patient, new areas in 2 patients and combined in 5 patients. The three patients who underwent RT in the first recurrence all had combined recurrences. RT did not prolong 2nd recurrence (p = 0.075). In this setting, RT was used in 4 patients as EF-RT (1), IF-RT (2) or consolidating RT (1). A third recurrence was observed in 5 patients after 3.8 years (0.2 y − 7.5 y). During their treatment, 7 patients received brentuximab-vedotin, 3 of which were treated subsequently with nivolumab. With 2 deaths in the cohort, overall survival was at median 12.3 y (3.9 y - 20.7 y 95% CI).
Conclusions: RT retains its pivotal role as local therapy in the setting of r/r HL and adds to the therapeutic mosaic in the era of targeted therapy1.
1Int J Radiat Oncol Biol Phys. 2018 Apr 1;100 (5):1100–1118.