Consolidation radiotherapy in patients with advanced Hodgkin lymphoma: survival data from the UKLG LY09 randomised controlled trial (ISRCTN97144519)
Consolidation radiotherapy in patients with advanced Hodgkin lymphoma: survival data from the UKLG LY09 randomised controlled trial (ISRCTN97144519)
Purpose: this study analyzed the outcomes of nonrandomized consolidation radiotherapy (RT) given after chemotherapy in the initial treatment of advanced Hodgkin's lymphoma (HL). The results were collected prospectively within a randomized controlled trial of induction chemotherapy.
Patients and methods: patients were randomly assigned between doxorubicin, bleomycin, vinblastine, and dacarbazine and one of two prespecified multidrug regimens. At least six cycles of chemotherapy were planned, with up to eight for patients showing slower response. Involved-field RT was recommended for incomplete response to chemotherapy or bulk disease at presentation. The primary outcome measure was progression-free survival (PFS), landmarked from the end of chemotherapy.
Results: among 807 patients randomly assigned, 702 achieved objective response. Postchemotherapy RT for consolidation was reported in 300 (43%). With median follow-up of 6.9 years, 161 PFS events and 83 deaths were reported. Baseline characteristics showed more patients with bulk disease having RT (190 [63%] v 111 [28%]) and only partial response after chemotherapy (150 [50%] v 36 [9%]). Other baseline characteristics were similar. PFS was superior for patients having RT (hazard ratio [HR], 0.43; 95% CI, 0.30 to 0.60) with 5-year PFS 71% without RT, 86% with RT. A similar advantage was seen for overall survival (HR, 0.47; 95% CI, 0.29 to 0.77). There was no evidence of heterogeneity of treatment effect across subgroups.
Conclusion: patients who received consolidation RT apparently had better outcomes, consistently across all prognostic groups which persisted in multivariate analysis. This suggests that RT contributes significantly to the cure rate for advanced HL, although patient selection for combined modality treatment requires better definition in prospective trials.
3352-3359
Johnson, P.W.M.
3f6068ce-171e-4c2c-aca9-dc9b6a37413f
Sydes, M.R.
bec44176-a377-4bfb-87c1-f5397426fcf4
Hancock, B.W.
7c4cea61-ac80-4f40-ad12-6504d027ceab
Cullen, M.
d3dee1e2-b7bb-4c38-a94a-ae3e5cc0b544
Radford, J.A.
77dd6342-413d-47e4-8c72-1b7829efba99
Stenning, S.P.
322b2b99-e6c5-46e5-a581-acb46357a418
10 July 2010
Johnson, P.W.M.
3f6068ce-171e-4c2c-aca9-dc9b6a37413f
Sydes, M.R.
bec44176-a377-4bfb-87c1-f5397426fcf4
Hancock, B.W.
7c4cea61-ac80-4f40-ad12-6504d027ceab
Cullen, M.
d3dee1e2-b7bb-4c38-a94a-ae3e5cc0b544
Radford, J.A.
77dd6342-413d-47e4-8c72-1b7829efba99
Stenning, S.P.
322b2b99-e6c5-46e5-a581-acb46357a418
Johnson, P.W.M., Sydes, M.R., Hancock, B.W., Cullen, M., Radford, J.A. and Stenning, S.P.
(2010)
Consolidation radiotherapy in patients with advanced Hodgkin lymphoma: survival data from the UKLG LY09 randomised controlled trial (ISRCTN97144519).
Journal of Clinical Oncology, 28 (20), .
(doi:10.1200/JCO.2009.26.0323).
(PMID:20498402)
Abstract
Purpose: this study analyzed the outcomes of nonrandomized consolidation radiotherapy (RT) given after chemotherapy in the initial treatment of advanced Hodgkin's lymphoma (HL). The results were collected prospectively within a randomized controlled trial of induction chemotherapy.
Patients and methods: patients were randomly assigned between doxorubicin, bleomycin, vinblastine, and dacarbazine and one of two prespecified multidrug regimens. At least six cycles of chemotherapy were planned, with up to eight for patients showing slower response. Involved-field RT was recommended for incomplete response to chemotherapy or bulk disease at presentation. The primary outcome measure was progression-free survival (PFS), landmarked from the end of chemotherapy.
Results: among 807 patients randomly assigned, 702 achieved objective response. Postchemotherapy RT for consolidation was reported in 300 (43%). With median follow-up of 6.9 years, 161 PFS events and 83 deaths were reported. Baseline characteristics showed more patients with bulk disease having RT (190 [63%] v 111 [28%]) and only partial response after chemotherapy (150 [50%] v 36 [9%]). Other baseline characteristics were similar. PFS was superior for patients having RT (hazard ratio [HR], 0.43; 95% CI, 0.30 to 0.60) with 5-year PFS 71% without RT, 86% with RT. A similar advantage was seen for overall survival (HR, 0.47; 95% CI, 0.29 to 0.77). There was no evidence of heterogeneity of treatment effect across subgroups.
Conclusion: patients who received consolidation RT apparently had better outcomes, consistently across all prognostic groups which persisted in multivariate analysis. This suggests that RT contributes significantly to the cure rate for advanced HL, although patient selection for combined modality treatment requires better definition in prospective trials.
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e-pub ahead of print date: 24 May 2010
Published date: 10 July 2010
Organisations:
Cancer Sciences
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Local EPrints ID: 73517
URI: http://eprints.soton.ac.uk/id/eprint/73517
ISSN: 1527-7755
PURE UUID: 3dbc23ec-fe8d-4613-bc32-87bafd04b06c
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Date deposited: 11 Mar 2010
Last modified: 14 Mar 2024 02:41
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Author:
M.R. Sydes
Author:
B.W. Hancock
Author:
M. Cullen
Author:
J.A. Radford
Author:
S.P. Stenning
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