HD15-25 · Title: HD15-25 Author: PC Created Date: 10/22/2014 7:13:47 AM
Response-adapted Therapy using FDG-PET after BEACOPP-chemotherapy in Advanced Stage Hodgkin's...
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Results: The mean age of all patients is 82 years (range, 63-91). There were 4 (50%) males and 4 (50%) females. Histologically, 5 (63%) patients had adenocarcinoma and 3 (37%) had squamous cell carcinoma. At the time of this review all patients are still alive with follow-up of 1-15 months. There was 1 local failure in one lesion that occurred 4 months after completing radiation treatment. There were no cases of acute grade 3 or worse toxicity. One patient experienced late grade 3 pulmonary toxicity. Conclusions: Although longer follow-up is needed, preliminary results show that using SBRT for bilateral multiple tumors can be delivered effectively with an acceptable toxicity profile. Author Disclosure: K.E. Rosenzweig, None; B. Laser, None; E.D. Yorke, None; H. Chan, None; M. Lovelock, None. 2675 Response-adapted Therapy using FDG-PETafter BEACOPP-chemotherapy in Advanced Stage Hodgkin’s Lymphoma - An Interim Analysis of the German Hodgkin Study Group (GHSG) Trial HD15 H. T. Eich 1 , C. Kobe 2 , M. Dietlein 2 , A. Engert 3 , J. Kriz 1 , R. P. Mueller 1 1 Department of Radiation Oncology, University of Cologne, Cologne, Germany, 2 Department of Nuclear Medicine, University of Cologne, Cologne, Germany, 3 Clinic I for Internal Medicine, University of Cologne, Cologne, Germany Purpose/Objective(s): In the HD15 trial of the German Hodgkin Study Group (GHSG) the prognostic value of positron emission tomography (PET) after BEACOPP chemotherapy in advanced-stage Hodgkin lymphoma (HL) patients was evaluated. Materials/Methods: Between January 2003 and July 2005, 817 patients with newly diagnosed, histology-proven HL in clinical stages IIB with clinical risk factors, III and IV were enrolled and randomly assigned to receive 6 or 8 cycles of BEACOPP escalated or 8 cycles of BEACOPP14 baseline . Radiotherapy (RT) was restricted to PET-positive (PET+) patients after chemotherapy. Entry criteria for PET included a partial remission (PR) after chemotherapy with at least one involved nodal site measuring $2.5cm in diameter. The major endpoint of this study was the negative predictive value (NPV) of PET, defined as the proportion of PET-negative (PET-) patients without progression, relapse or irradiation after 12 months of follow-up. Results: In this predefined interim analysis, 79% evaluable patients were PET- and 21% were PET+ after 6-8 cycles of BEACOPP and received additional radiotherapy. PFS at 12 months was 96% for PET- patients and 85% for PET+ patients (p = 0.011). The NPV for PET at 12 months in this analysis was 94% (95%; CI 0.91, 0.97). Conclusions: Radiotherapy following 6 or 8 cycles of BEACOPP may be restricted to those patients who are PET+ after chemo- therapy. Author Disclosure: H.T. Eich, None; C. Kobe, None; M. Dietlein, None; A. Engert, None; J. Kriz, None; R.P. Mueller, None. 2676 The Significance of a Positive PET Scan after Chemotherapy with ABVD and Prior to Involved Field Radiation Therapy in Hodgkin’s Lymphoma A. Ghafoori, R. Clough, T. Z. Wong, L. Prosnitz, C. Kelsey Duke University Medical Center, Durham, NC Purpose/Objectives: The preferred treatment of stage I-II Hodgkin’s lymphoma (HL) is chemotherapy, most commonly ABVD, followed by involved field radiation therapy (IFRT). The role of IFRT in advanced HL is controversial. Positron emission tomog- raphy (PET) is increasingly utilized for both initial staging and to assess response to treatment. The significance of a positive PET before IFRT in patients who respond to ABVD is unclear. As patient management is often predicated on PET response, we sought to investigate this issue further. Materials/Methods: This IRB-approved analysis included all patients who received ABVD for HL and who underwent PET imaging prior to initiating IFRT. A positive PET was defined in accordance with the International Harmonization Project in Lym- phoma as a visual assessment of persistent FDG-uptake. Freedom from progression (FFP) was computed using the Kaplan-Meier method. Univariate regression analysis and Fisher’s exact test were performed to evaluate the effect of known prognostic factors (age, stage, B symptoms, ESR level with or without B symptoms, number of involved sites, extranodal involvement, large medi- astinal mass) on FFP and the likelihood of having a positive post-ABVD PET, respectively. Results: Between 2000 and 2006, 42 patients were judged to have a clinical complete or partial response to ABVD prior to PET imaging. 64% were stage I-II, 36% were stage III-IV. Patients received a median of 6 cycles of ABVD (range, 4-6). The post- ABVD PET was negative in 33/42 (79%) and positive in 9/42 (21%) patients. The median IFRT dose was 20 Gy (range, 17.1- 36 Gy) for PET negative and 25 Gy (range, 18.8-36) for PET positive patients. With a median follow-up of 2.8 years, 2/33 PET negative patients failed compared with 1/9 PET positive patients (p = 0.52). The FFP at 3 years was 92% for PET negative and 89% for PET positive patients (p = 0.68). There were no statistically significant predictors of inferior FFP, though the number of events was small. Similarly, there were no statistically significant predictors of a positive post-ABVD PET scan. Conclusions: We did not observe a higher rate of failure in patients who responded to ABVD yet had a persistently positive PET prior to low-dose IFRT. Whether our findings are due to limitations of PET imaging and/or interpretation or due to the efficacy of IFRT is unclear. Further investigation with a larger group of patients is necessary to confirm these findings. Author Disclosure: A. Ghafoori, None; R. Clough, None; T.Z. Wong, None; L. Prosnitz, None; C. Kelsey, None. 2677 Two Distinct Subtypes of Nasal-type NK/T Cell Lymphoma: Clinical Features and Treatment Outcome According to Primary Site of the Nasal Cavity or Waldeyer’s Ring H. Fang, Y. Li, Q. Liu, S. Qi, J. Jin, W. Wang, Y. Liu, Y. Song, S. Wang, Z. Yu Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China Purpose/Objective(s): To define the clinical characteristics, prognosis and treatment outcome for nasal-type NK/T cell lymphoma of Waldeyer’s ring (WR-NKTL) and nasal NK/T cell lymphoma (N-NKTL). Proceedings of the 50th Annual ASTRO Meeting S471
Transcript of Response-adapted Therapy using FDG-PET after BEACOPP-chemotherapy in Advanced Stage Hodgkin's...
Proceedings of the 50th Annual ASTRO Meeting S471
Results: The mean age of all patients is 82 years (range, 63-91). There were 4 (50%) males and 4 (50%) females. Histologically, 5(63%) patients had adenocarcinoma and 3 (37%) had squamous cell carcinoma. At the time of this review all patients are still alivewith follow-up of 1-15 months. There was 1 local failure in one lesion that occurred 4 months after completing radiation treatment.There were no cases of acute grade 3 or worse toxicity. One patient experienced late grade 3 pulmonary toxicity.
Conclusions: Although longer follow-up is needed, preliminary results show that using SBRT for bilateral multiple tumors can bedelivered effectively with an acceptable toxicity profile.
Author Disclosure: K.E. Rosenzweig, None; B. Laser, None; E.D. Yorke, None; H. Chan, None; M. Lovelock, None.
2675 Response-adapted Therapy using FDG-PETafter BEACOPP-chemotherapy in Advanced Stage Hodgkin’s
Lymphoma - An Interim Analysis of the German Hodgkin Study Group (GHSG) Trial HD15H. T. Eich1, C. Kobe2, M. Dietlein2, A. Engert3, J. Kriz1, R. P. Mueller1
1Department of Radiation Oncology, University of Cologne, Cologne, Germany, 2Department of Nuclear Medicine, Universityof Cologne, Cologne, Germany, 3Clinic I for Internal Medicine, University of Cologne, Cologne, Germany
Purpose/Objective(s): In the HD15 trial of the German Hodgkin Study Group (GHSG) the prognostic value of positron emissiontomography (PET) after BEACOPP chemotherapy in advanced-stage Hodgkin lymphoma (HL) patients was evaluated.
Materials/Methods: Between January 2003 and July 2005, 817 patients with newly diagnosed, histology-proven HL in clinicalstages IIB with clinical risk factors, III and IV were enrolled and randomly assigned to receive 6 or 8 cycles of BEACOPPescalated or8 cycles of BEACOPP14baseline. Radiotherapy (RT) was restricted to PET-positive (PET+) patients after chemotherapy. Entrycriteria for PET included a partial remission (PR) after chemotherapy with at least one involved nodal site measuring $2.5cmin diameter. The major endpoint of this study was the negative predictive value (NPV) of PET, defined as the proportion ofPET-negative (PET-) patients without progression, relapse or irradiation after 12 months of follow-up.
Results: In this predefined interim analysis, 79% evaluable patients were PET- and 21% were PET+ after 6-8 cycles of BEACOPPand received additional radiotherapy. PFS at 12 months was 96% for PET- patients and 85% for PET+ patients (p = 0.011). TheNPV for PET at 12 months in this analysis was 94% (95%; CI 0.91, 0.97).
Conclusions: Radiotherapy following 6 or 8 cycles of BEACOPP may be restricted to those patients who are PET+ after chemo-therapy.
Author Disclosure: H.T. Eich, None; C. Kobe, None; M. Dietlein, None; A. Engert, None; J. Kriz, None; R.P. Mueller, None.
2676 The Significance of a Positive PET Scan after Chemotherapy with ABVD and Prior to Involved Field
Radiation Therapy in Hodgkin’s LymphomaA. Ghafoori, R. Clough, T. Z. Wong, L. Prosnitz, C. Kelsey
Duke University Medical Center, Durham, NC
Purpose/Objectives: The preferred treatment of stage I-II Hodgkin’s lymphoma (HL) is chemotherapy, most commonly ABVD,followed by involved field radiation therapy (IFRT). The role of IFRT in advanced HL is controversial. Positron emission tomog-raphy (PET) is increasingly utilized for both initial staging and to assess response to treatment. The significance of a positive PETbefore IFRT in patients who respond to ABVD is unclear. As patient management is often predicated on PET response, we soughtto investigate this issue further.
Materials/Methods: This IRB-approved analysis included all patients who received ABVD for HL and who underwent PETimaging prior to initiating IFRT. A positive PET was defined in accordance with the International Harmonization Project in Lym-phoma as a visual assessment of persistent FDG-uptake. Freedom from progression (FFP) was computed using the Kaplan-Meiermethod. Univariate regression analysis and Fisher’s exact test were performed to evaluate the effect of known prognostic factors(age, stage, B symptoms, ESR level with or without B symptoms, number of involved sites, extranodal involvement, large medi-astinal mass) on FFP and the likelihood of having a positive post-ABVD PET, respectively.
Results: Between 2000 and 2006, 42 patients were judged to have a clinical complete or partial response to ABVD prior to PETimaging. 64% were stage I-II, 36% were stage III-IV. Patients received a median of 6 cycles of ABVD (range, 4-6). The post-ABVD PET was negative in 33/42 (79%) and positive in 9/42 (21%) patients. The median IFRT dose was 20 Gy (range, 17.1-36 Gy) for PET negative and 25 Gy (range, 18.8-36) for PET positive patients. With a median follow-up of 2.8 years, 2/33PET negative patients failed compared with 1/9 PET positive patients (p = 0.52). The FFP at 3 years was 92% for PET negativeand 89% for PET positive patients (p = 0.68). There were no statistically significant predictors of inferior FFP, though the numberof events was small. Similarly, there were no statistically significant predictors of a positive post-ABVD PET scan.
Conclusions: We did not observe a higher rate of failure in patients who responded to ABVD yet had a persistently positive PETprior to low-dose IFRT. Whether our findings are due to limitations of PET imaging and/or interpretation or due to the efficacy ofIFRT is unclear. Further investigation with a larger group of patients is necessary to confirm these findings.
Author Disclosure: A. Ghafoori, None; R. Clough, None; T.Z. Wong, None; L. Prosnitz, None; C. Kelsey, None.
2677 Two Distinct Subtypes of Nasal-type NK/T Cell Lymphoma: Clinical Features and Treatment Outcome
According to Primary Site of the Nasal Cavity or Waldeyer’s RingH. Fang, Y. Li, Q. Liu, S. Qi, J. Jin, W. Wang, Y. Liu, Y. Song, S. Wang, Z. Yu
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union MedicalCollege (PUMC), Beijing, China
Purpose/Objective(s): To define the clinical characteristics, prognosis and treatment outcome for nasal-type NK/T cell lymphomaof Waldeyer’s ring (WR-NKTL) and nasal NK/T cell lymphoma (N-NKTL).
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