- Email: [email protected]
Value of PET Restaging After Chemotherapy for Non-Hodgkins Lymphoma: Implications for Consolidation Radiotherapy
S422
I. J. Radiation Oncology
● Biology ● Physics
Volume 63, Number 2, Supplement, 2005
RT was complete. Of 16 sites associated with pre-IFRT pain or discomfort, 15 (94%) exhibited post-IFRT pain relief. Thirteen sites (34%) exhibited LP, with a median time to LP of 10 months (range 1–39), and an average LR duration of 9 months. Five patients (24%) experienced grade 2 radiation-related toxicity. No grade 3 toxicity was reported. The 12-month OS for patients receiving IFRT was 55%. Conclusions: IFRT is capable of obtaining effective and lasting local responses in patients with MCL and is associated with only minimal toxicity. The radiation doses required for most lesions were relatively low and the responses were noticed early in the course of treatment. Radiation therapy should be considered early in the course of relapsing, refractory or localized MCL.
2322
Value of PET Restaging After Chemotherapy for Non-Hodgkins Lymphoma: Implications for Consolidation Radiotherapy
S. Kahn,1 M. Koshy,1 C. Flowers,2 M. Lechowicz,2 K. Hollenbach,3 P.A. Johnstone1,2 Radiation Oncology, Emory University, Atlanta, GA, 2Winship Cancer Institute, Emory University, Atlanta, GA, 3Beta Statistics, San Diego, CA 1
Purpose/Objective: Patients receiving chemotherapy for Non-Hodgkins Lymphoma (NHL) frequently are restaged afterwards for response using positron emission tomography (PET) scanning. This study investigates the role of subsequent consolidation radiation therapy (RT) based on PET response to chemotherapy. Materials/Methods: The IRB-approved database of the Lymphoma Clinic at the Winship Cancer Institute of Emory University was retrospectively queried for patients (pts) who underwent PET scans after treatment of NHL consisting only of chemotherapy between 1995 and 2004. Seventy-seven pts were identified. To determine if benefit was attained by the use of consolidation RT, these pts were subsequently followed for a median of 8.4 months (range 3.5 - 61.8 months) to determine overall survival and local control. Results: Median age of pts was 53 years (range 18 – 82 years). A multivariate analysis was performed to analyze factors influencing recurrent disease; age, indolent vs. aggressive histology, and time from chemotherapy to PET did not. PET positive scans (RR⫽ 30.5, 95%CI⫽5.9, 156.4), stage I/II presentation (RR⫽ 0.23, 95%CI⫽0.05, 0.97), and lack of RT (RR⫽5.25, 95%CI⫽1.26, 21.79) all predicted increased likelihood of recurrence. Patients who had persistently ⫹ PET scans after chemotherapy had a significantly higher risk of subsequent relapse than those whose PET scans cleared (58.1% vs 15.2%; p⬍0.0001), although not everyone with positive scans recurred. Patients with ⫹ PET scans receiving consolidation RT were not protected from relapse when compared to PET ⫹ patients not receiving consolidation RT (63.2% relapse with RT, 50% relapse without RT; p ⫽ 0.71). In fact, over half of the relapses in patients receiving RT for persistently ⫹ PET scans were in-field. For patients who had - PET scans after chemotherapy, consolidation RT contributed to numerically fewer relapses (6.2% vs 20%; p ⫽ 0.39). Survival was not significantly different between PET ⫹ and PET - cohorts, related to adequate salvage techniques available and relatively short follow-up. Conclusions: While RT may control relapse in PET - patients, NHL patients who remain PET ⫹ after chemotherapy are not well managed by RT alone. Supported by grants from the Georgia Cancer Coalition.
2323
A Dosimetric Study of Mantle Versus Involved-Field Radiotherapy for Hodgkin’s Lymphoma: Implications for Second Cancer Risk and Cardiac Toxicity
E. Koh,1,4 T. Tran,1 M. Heydarian,1,4 R. Tsang,1,4 M. Pintilie,2 M. Gospodarowicz,1,4 A. Sun,1,4 W. Wells,1,4 N. Paul,3,4 D. Hodgson1,4 1 Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada, 2Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada, 3Department of Medical Imaging, Princess Margaret Hospital, Toronto, ON, Canada, 4University of Toronto, Toronto, ON, Canada Purpose/Objective: Hodgkin’s Lymphoma (HL) survivors treated with RT are known to be at increased risk of second cancers (SC) and cardiovascular disease (CVD). However, involved-field RT (IFRT) is the current practice for most patients, and there is early evidence that reduced dose IFRT (20Gy) may be equally effective. These changes have implications for reducing SC and CVD risk. This study was undertaken to compare the radiation dose to normal tissues among patients with mediastinal HL treated with: 1. Mantle RT - 35Gy 2. IFRT - 35Gy 3. IFRT - 20Gy.
I. J. Radiation Oncology
● Biology ● Physics
Volume 63, Number 2, Supplement, 2005
RT was complete. Of 16 sites associated with pre-IFRT pain or discomfort, 15 (94%) exhibited post-IFRT pain relief. Thirteen sites (34%) exhibited LP, with a median time to LP of 10 months (range 1–39), and an average LR duration of 9 months. Five patients (24%) experienced grade 2 radiation-related toxicity. No grade 3 toxicity was reported. The 12-month OS for patients receiving IFRT was 55%. Conclusions: IFRT is capable of obtaining effective and lasting local responses in patients with MCL and is associated with only minimal toxicity. The radiation doses required for most lesions were relatively low and the responses were noticed early in the course of treatment. Radiation therapy should be considered early in the course of relapsing, refractory or localized MCL.
2322
Value of PET Restaging After Chemotherapy for Non-Hodgkins Lymphoma: Implications for Consolidation Radiotherapy
S. Kahn,1 M. Koshy,1 C. Flowers,2 M. Lechowicz,2 K. Hollenbach,3 P.A. Johnstone1,2 Radiation Oncology, Emory University, Atlanta, GA, 2Winship Cancer Institute, Emory University, Atlanta, GA, 3Beta Statistics, San Diego, CA 1
Purpose/Objective: Patients receiving chemotherapy for Non-Hodgkins Lymphoma (NHL) frequently are restaged afterwards for response using positron emission tomography (PET) scanning. This study investigates the role of subsequent consolidation radiation therapy (RT) based on PET response to chemotherapy. Materials/Methods: The IRB-approved database of the Lymphoma Clinic at the Winship Cancer Institute of Emory University was retrospectively queried for patients (pts) who underwent PET scans after treatment of NHL consisting only of chemotherapy between 1995 and 2004. Seventy-seven pts were identified. To determine if benefit was attained by the use of consolidation RT, these pts were subsequently followed for a median of 8.4 months (range 3.5 - 61.8 months) to determine overall survival and local control. Results: Median age of pts was 53 years (range 18 – 82 years). A multivariate analysis was performed to analyze factors influencing recurrent disease; age, indolent vs. aggressive histology, and time from chemotherapy to PET did not. PET positive scans (RR⫽ 30.5, 95%CI⫽5.9, 156.4), stage I/II presentation (RR⫽ 0.23, 95%CI⫽0.05, 0.97), and lack of RT (RR⫽5.25, 95%CI⫽1.26, 21.79) all predicted increased likelihood of recurrence. Patients who had persistently ⫹ PET scans after chemotherapy had a significantly higher risk of subsequent relapse than those whose PET scans cleared (58.1% vs 15.2%; p⬍0.0001), although not everyone with positive scans recurred. Patients with ⫹ PET scans receiving consolidation RT were not protected from relapse when compared to PET ⫹ patients not receiving consolidation RT (63.2% relapse with RT, 50% relapse without RT; p ⫽ 0.71). In fact, over half of the relapses in patients receiving RT for persistently ⫹ PET scans were in-field. For patients who had - PET scans after chemotherapy, consolidation RT contributed to numerically fewer relapses (6.2% vs 20%; p ⫽ 0.39). Survival was not significantly different between PET ⫹ and PET - cohorts, related to adequate salvage techniques available and relatively short follow-up. Conclusions: While RT may control relapse in PET - patients, NHL patients who remain PET ⫹ after chemotherapy are not well managed by RT alone. Supported by grants from the Georgia Cancer Coalition.
2323
A Dosimetric Study of Mantle Versus Involved-Field Radiotherapy for Hodgkin’s Lymphoma: Implications for Second Cancer Risk and Cardiac Toxicity
E. Koh,1,4 T. Tran,1 M. Heydarian,1,4 R. Tsang,1,4 M. Pintilie,2 M. Gospodarowicz,1,4 A. Sun,1,4 W. Wells,1,4 N. Paul,3,4 D. Hodgson1,4 1 Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada, 2Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada, 3Department of Medical Imaging, Princess Margaret Hospital, Toronto, ON, Canada, 4University of Toronto, Toronto, ON, Canada Purpose/Objective: Hodgkin’s Lymphoma (HL) survivors treated with RT are known to be at increased risk of second cancers (SC) and cardiovascular disease (CVD). However, involved-field RT (IFRT) is the current practice for most patients, and there is early evidence that reduced dose IFRT (20Gy) may be equally effective. These changes have implications for reducing SC and CVD risk. This study was undertaken to compare the radiation dose to normal tissues among patients with mediastinal HL treated with: 1. Mantle RT - 35Gy 2. IFRT - 35Gy 3. IFRT - 20Gy.