intensive first-line therapy

Relevance of Positron-Emission Therapy for Optimization of Treatment of Advanced Hodgkin’s Lymphoma Using Intensive ЕАСОРР-14 Program

LYMPHOID TUMORS , ,

EA Demina1, AA Leont’eva1, GS Tumyan1, YuE Ryabukhina1, EG Medvedovskaya1, OP Trofimova1, VM Sotnikov2, VB Larionova1, EV Paramonova1, LV Manzyuk1, NV Kokosadze1, OV Mukhortova3, IP Aslanidi3, AYu Zaitseva4, LA Radkevich4, MS Rudas5, VA Manukova5, EA Osmanov1

1 NN Blokhin Russian Cancer Research Center, 24 Kashirskoye sh., Moscow, Russian Federation, 115478

2 Russian Scientific Center of Roentgenoradiology under the Ministry of Health of the Russian Federation, 86 bld. 5 Profsoyuznaya str., Moscow, Russian Federation, 117997

3 AN Bakulev Scientific Center for Cardiovascular Surgery, 8 bld. 7 Leninskii pr-t, Moscow, Russian Federation, 117931

4 Clinical Hospital No. 1 under the Administration of Presidential Affairs of the Russian Federation, 45 Losinoostrovskaya str., Moscow, Russian Federation, 107150

5 Central Clinical Hospital under the Administration of Presidential Affairs of the Russian Federation, 15 Marshala Timoshenko str., Moscow, Russian Federation, 121359

For correspondence: Elena Andreevna Demina, DSci, Professor, 24 Kashirskoye sh., Moscow, Russian Federation, 115478; Tel: +7(499)324-90-89; e-mail: drdemina@yandex.ru

For citation: Demina EA, Leont’eva AA, Tumyan GS, et al. Relevance of Positron-Emission Therapy for Optimization of Treatment of Advanced Hodgkin’s Lymphoma Using Intensive ЕАСОРР-14 Program. Clinical oncohematology. 2017;10(2):150–7 (In Russ).

DOI: 10.21320/2500-2139-2017-10-2-150-157

ABSTRACT

Aim. To evaluate the relevance of the positron-emission therapy (PET) for optimization of the therapy of advanced Hodgkin’s lymphoma (HL) using the intensive EACOPP-14 program.

Materials & Methods. 91 patients with advanced HL (IIX–IIE, III–IV) received the treatment according to the “ЛХМосква1-3” protocol over the period from November 2009 to February 2015, and then the treatment was analyzed. The median age was 29 years (range: 17–50); there were 42 men (46.3 %) and 49 (53.7 %) women. The treatment included 6 cycles of polychemotherapy according to the regimen ЕА(50)СОРР-14 ± radiation therapy. The radiation therapy was performed in 66 patients (72.5 %) after the completion of the chemotherapy. The cumulative focal dose was 30 Gy onto the areas of residual lesions and/or initially large tumor masses.

Results. PET performed during the initial HL diagnosing permited to identify new areas of neoplastic lesions without changes in staging and treatment scheme, as well as specify areas and field size of planned radiation consolidation. The paper confirms the prognostic value of the intermediate PET in patients with advanced HL during the intensive first-line chemotherapy. The intensive therapy at the beginning of the treatment program is associated with higher chances for survival for patients with extremely unfavorable prognosis. After completion of the drug therapy, negative PET findings had a higher prognostic value, than the positive ones. The analysis of the relevance of residual tumor dimensions in the PET negative group demonstrated that the relapses were more common, if the residual tumor was more than 4.5 cm (according to CT findings).

Conclusion. This study confirmed that it reasonable to discuss the discontinuation of the radiation therapy in patients with advanced HL, negative PET findings and small (< 2.5 cm) residual tumor after the intensive ЕАСОРР-14 program. This tactics permits avoiding a number of delayed complications.

Keywords: Hodgkin’s lymphoma, advanced disease, intensive first-line therapy, PET.

Received: January 2, 2017

Accepted: January 14, 2017

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