Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95

Wolfgang Dörffel; Ursula Rühl; Heike Lüders; Alexander Claviez; Marion Albrecht; Jos Bökkerink; Harald Holte; Jonas Karlen; Georg Mann; Heinz Marciniak; Felix Niggli; K. Schmiegelow; Ernst-Wilhelm Schwarze; Richard Pötter; Lutz Wickmann; Günther Schellong

doi:10.1200/jco.2012.45.3266

Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95

Wolfgang Dörffel, Ursula Rühl, Heike Lüders, Alexander Claviez, Marion Albrecht, Jos Bökkerink, Harald Holte, Jonas Karlen, Georg Mann, Heinz Marciniak, Felix Niggli, K. Schmiegelow, Ernst-Wilhelm Schwarze, Richard Pötter, Lutz Wickmann, Günther Schellong

Institut for Klinisk Medicin

83 Citationer (Scopus)

Abstract

Purpose To minimize the risk of late effects in pediatric Hodgkin lymphoma (HL) by omitting radiotherapy (RT) in patients in complete remission (CR) after chemotherapy and reducing the standard radiation dose to 20 Gy in patients in incomplete remission. Patients and Methods Between 1995 and 2001, 925 patients with classical HL (cHL) were registered from seven European countries in German Society of Pediatric Oncology and Hematology Hodgkin Lymphoma Trial 95. Patients in treatment group 1 (TG1; early stages) received two cycles of vincristine, prednisone, procarbazine, and doxorubicin or vincristine, prednisone, etoposide, and doxorubicin chemotherapy; additional two or four cycles of cyclophosphamide, vincristine, prednisone, and procarbazine were added in TG2 (intermediate stages) or TG3 (advanced stages), respectively. Patients in CR (assessed by computed tomography or magnetic resonance imaging) did not undergo RT. Those with tumor volume reduction more than 75% received reduced involved-field RT with 20 Gy and an additional 10- or 15-Gy boost only for larger residuals. Results Rates of overall survival, progression-free survival (PFS), and event-free survival at 10 years were (± SE) 96.3% ± 0.6%, 88.2% ± 1.1%, and 85.4% ± 1.3%, respectively. PFS for TG1 patients without or with RT was 97.0% ± 2.1% versus 92.2% ± 1.7% (P = .214) but was unsatisfactory for nonirradiated patients in TG2 (68.5% ± 7.4% v 91.4% ± 1.9%; P < .0001), with similar but not significant results in TG3 (82.6% ± 5.4% v 88.7% ± 2.0%, P = .259). Reduction of the standard radiation dose from 25 to 20 Gy did not increase failure rate. Conclusion RT can be omitted in early stage HL in so defined CR following this chemotherapy. RT with 20(-35) Gy proved to be sufficient in patients with incomplete remission following chemotherapy.

Originalsprog	Engelsk
Tidsskrift	Journal of Clinical Oncology
Vol/bind	31
Udgave nummer	12
Sider (fra-til)	1562-1568
Antal sider	7
ISSN	0732-183X
DOI	https://doi.org/10.1200/jco.2012.45.3266
Status	Udgivet - 20 apr. 2013

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10.1200/jco.2012.45.3266

Citationsformater

Dörffel, W., Rühl, U., Lüders, H., Claviez, A., Albrecht, M., Bökkerink, J., Holte, H., Karlen, J., Mann, G., Marciniak, H., Niggli, F., Schmiegelow, K., Schwarze, E-W., Pötter, R., Wickmann, L., & Schellong, G. (2013). Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95 . Journal of Clinical Oncology, 31(12), 1562-1568. https://doi.org/10.1200/jco.2012.45.3266

Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy : Final Results of the Multinational Trial GPOH-HD95 . / Dörffel, Wolfgang; Rühl, Ursula; Lüders, Heike et al.

I: Journal of Clinical Oncology, Bind 31, Nr. 12, 20.04.2013, s. 1562-1568.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Dörffel, W, Rühl, U, Lüders, H, Claviez, A, Albrecht, M, Bökkerink, J, Holte, H, Karlen, J, Mann, G, Marciniak, H, Niggli, F, Schmiegelow, K, Schwarze, E-W, Pötter, R, Wickmann, L & Schellong, G 2013, 'Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95 ', Journal of Clinical Oncology, bind 31, nr. 12, s. 1562-1568. https://doi.org/10.1200/jco.2012.45.3266

@article{6c20791aa385401481caf340556f70c9,

title = "Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95 ",

abstract = "Purpose To minimize the risk of late effects in pediatric Hodgkin lymphoma (HL) by omitting radiotherapy (RT) in patients in complete remission (CR) after chemotherapy and reducing the standard radiation dose to 20 Gy in patients in incomplete remission. Patients and Methods Between 1995 and 2001, 925 patients with classical HL (cHL) were registered from seven European countries in German Society of Pediatric Oncology and Hematology Hodgkin Lymphoma Trial 95. Patients in treatment group 1 (TG1; early stages) received two cycles of vincristine, prednisone, procarbazine, and doxorubicin or vincristine, prednisone, etoposide, and doxorubicin chemotherapy; additional two or four cycles of cyclophosphamide, vincristine, prednisone, and procarbazine were added in TG2 (intermediate stages) or TG3 (advanced stages), respectively. Patients in CR (assessed by computed tomography or magnetic resonance imaging) did not undergo RT. Those with tumor volume reduction more than 75% received reduced involved-field RT with 20 Gy and an additional 10- or 15-Gy boost only for larger residuals. Results Rates of overall survival, progression-free survival (PFS), and event-free survival at 10 years were (± SE) 96.3% ± 0.6%, 88.2% ± 1.1%, and 85.4% ± 1.3%, respectively. PFS for TG1 patients without or with RT was 97.0% ± 2.1% versus 92.2% ± 1.7% (P = .214) but was unsatisfactory for nonirradiated patients in TG2 (68.5% ± 7.4% v 91.4% ± 1.9%; P < .0001), with similar but not significant results in TG3 (82.6% ± 5.4% v 88.7% ± 2.0%, P = .259). Reduction of the standard radiation dose from 25 to 20 Gy did not increase failure rate. Conclusion RT can be omitted in early stage HL in so defined CR following this chemotherapy. RT with 20(-35) Gy proved to be sufficient in patients with incomplete remission following chemotherapy.",

author = "Wolfgang D{\"o}rffel and Ursula R{\"u}hl and Heike L{\"u}ders and Alexander Claviez and Marion Albrecht and Jos B{\"o}kkerink and Harald Holte and Jonas Karlen and Georg Mann and Heinz Marciniak and Felix Niggli and K. Schmiegelow and Ernst-Wilhelm Schwarze and Richard P{\"o}tter and Lutz Wickmann and G{\"u}nther Schellong",

year = "2013",

month = apr,

day = "20",

doi = "10.1200/jco.2012.45.3266",

language = "English",

volume = "31",

pages = "1562--1568",

journal = "Journal of Clinical Oncology",

issn = "0732-183X",

publisher = "American Society of Clinical Oncology",

number = "12",

}

TY - JOUR

T1 - Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy

T2 - Final Results of the Multinational Trial GPOH-HD95

AU - Dörffel, Wolfgang

AU - Rühl, Ursula

AU - Lüders, Heike

AU - Claviez, Alexander

AU - Albrecht, Marion

AU - Bökkerink, Jos

AU - Holte, Harald

AU - Karlen, Jonas

AU - Mann, Georg

AU - Marciniak, Heinz

AU - Niggli, Felix

AU - Schmiegelow, K.

AU - Schwarze, Ernst-Wilhelm

AU - Pötter, Richard

AU - Wickmann, Lutz

AU - Schellong, Günther

PY - 2013/4/20

Y1 - 2013/4/20

N2 - Purpose To minimize the risk of late effects in pediatric Hodgkin lymphoma (HL) by omitting radiotherapy (RT) in patients in complete remission (CR) after chemotherapy and reducing the standard radiation dose to 20 Gy in patients in incomplete remission. Patients and Methods Between 1995 and 2001, 925 patients with classical HL (cHL) were registered from seven European countries in German Society of Pediatric Oncology and Hematology Hodgkin Lymphoma Trial 95. Patients in treatment group 1 (TG1; early stages) received two cycles of vincristine, prednisone, procarbazine, and doxorubicin or vincristine, prednisone, etoposide, and doxorubicin chemotherapy; additional two or four cycles of cyclophosphamide, vincristine, prednisone, and procarbazine were added in TG2 (intermediate stages) or TG3 (advanced stages), respectively. Patients in CR (assessed by computed tomography or magnetic resonance imaging) did not undergo RT. Those with tumor volume reduction more than 75% received reduced involved-field RT with 20 Gy and an additional 10- or 15-Gy boost only for larger residuals. Results Rates of overall survival, progression-free survival (PFS), and event-free survival at 10 years were (± SE) 96.3% ± 0.6%, 88.2% ± 1.1%, and 85.4% ± 1.3%, respectively. PFS for TG1 patients without or with RT was 97.0% ± 2.1% versus 92.2% ± 1.7% (P = .214) but was unsatisfactory for nonirradiated patients in TG2 (68.5% ± 7.4% v 91.4% ± 1.9%; P < .0001), with similar but not significant results in TG3 (82.6% ± 5.4% v 88.7% ± 2.0%, P = .259). Reduction of the standard radiation dose from 25 to 20 Gy did not increase failure rate. Conclusion RT can be omitted in early stage HL in so defined CR following this chemotherapy. RT with 20(-35) Gy proved to be sufficient in patients with incomplete remission following chemotherapy.

AB - Purpose To minimize the risk of late effects in pediatric Hodgkin lymphoma (HL) by omitting radiotherapy (RT) in patients in complete remission (CR) after chemotherapy and reducing the standard radiation dose to 20 Gy in patients in incomplete remission. Patients and Methods Between 1995 and 2001, 925 patients with classical HL (cHL) were registered from seven European countries in German Society of Pediatric Oncology and Hematology Hodgkin Lymphoma Trial 95. Patients in treatment group 1 (TG1; early stages) received two cycles of vincristine, prednisone, procarbazine, and doxorubicin or vincristine, prednisone, etoposide, and doxorubicin chemotherapy; additional two or four cycles of cyclophosphamide, vincristine, prednisone, and procarbazine were added in TG2 (intermediate stages) or TG3 (advanced stages), respectively. Patients in CR (assessed by computed tomography or magnetic resonance imaging) did not undergo RT. Those with tumor volume reduction more than 75% received reduced involved-field RT with 20 Gy and an additional 10- or 15-Gy boost only for larger residuals. Results Rates of overall survival, progression-free survival (PFS), and event-free survival at 10 years were (± SE) 96.3% ± 0.6%, 88.2% ± 1.1%, and 85.4% ± 1.3%, respectively. PFS for TG1 patients without or with RT was 97.0% ± 2.1% versus 92.2% ± 1.7% (P = .214) but was unsatisfactory for nonirradiated patients in TG2 (68.5% ± 7.4% v 91.4% ± 1.9%; P < .0001), with similar but not significant results in TG3 (82.6% ± 5.4% v 88.7% ± 2.0%, P = .259). Reduction of the standard radiation dose from 25 to 20 Gy did not increase failure rate. Conclusion RT can be omitted in early stage HL in so defined CR following this chemotherapy. RT with 20(-35) Gy proved to be sufficient in patients with incomplete remission following chemotherapy.

U2 - 10.1200/jco.2012.45.3266

DO - 10.1200/jco.2012.45.3266

M3 - Journal article

C2 - 23509321

SN - 0732-183X

VL - 31

SP - 1562

EP - 1568

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 12

ER -

Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95

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