OC-0502 Role of consolidation RT to bulky lesions of advanced Hodgkin lymphoma: results of FIL HD0801 trial

Involved Site Radiation Therapy in Adult Lymphomas: An Overview of International Lymphoma Radiation Oncology Group Guidelines

“…3 Randomized studies in advanced-stage disease report small, nonstatistically significant increases in PFS with RT to initial bulky masses achieving PET CR. 98,99 The use of modified ISRT gains some support from the observation that small-volume disease sites in early PET complete remission are often controlled by systemic therapy alone. 3,68,93 A small retrospective study of HL treated with chemotherapy suggested that small cardiophrenic nodes can safely be omitted from the irradiated volume.…”

“…90 In 2 recent Italian trials (GITIL 0607 and FIL HD0801), consolidative RT to bulky sites (>5 cm) in PET CR after ABVD chemotherapy was associated with nonstatistically significant increases in PFS of 4% and 7.5% (intention-to-treat analysis), respectively. 98,99 Rapidity of metabolic response has been used to guide RT use in pediatric patient trials, and a recent analysis of SWOG S0816 suggests that interim PET may guide the use of consolidative RT. 136,137 This is supported by an unplanned analysis of the UK RATHL trial, suggesting a benefit from RT for patients with positive interim PET.…”

Radiation Therapy for Advanced-Stage Hodgkin Lymphoma

“…The phase III portion of the trial has only been published thus far in abstract form. 15 An intention-to-treat analysis showed similar PFS in both arms, and the per-protocol analysis showed that consolidation RT was associated with a 10.3% PFS benefit at 3 years and a 7.5% benefit at 5 years compared with no RT, although the findings were not statistically significant. The authors note there was a limited sample size and low number of events.…”

“…Two more recent studies have examined the role of consolidation radiation to bulky lesions in AS-HL despite the achievement of rapid early response to chemotherapy: the Italian GITIL/FIL (Gruppo Italiano Terapie Innovative nei Linfomi/Fondazione Italiana Linfomi) trial HD 0607 14 and FIL (Fondazione Italiana Linfomi) trial HD 0801. 15 The GITIL/FIL trial HD 0607 enrolled patients with stage IIB to IVB HL and, after 2 cycles of ABVD, randomly assigned patients with positive PET to 4 cycles of escalated BEACOPP versus standard BEACOPP with or without rituximab. Interim PET was defined as positive if the Deauville score was 4 to 5.…”

“…26 When opting to consolidate with postchemotherapy radiation to sites of initial bulky disease, the definition of initial bulky disease has most commonly been defined as diameter >5 cm. [13][14][15] The recommended dose for bulky disease ranges from 30 to 36 Gy at 1.5 to 2.0 Gy per fraction, and for residual PET-positive disease postchemotherapy is 36 to 40 Gy, per ILROG, or 36 to 45 Gy, per NCCN. 6,26,27 Patterns of relapse studies prove to be informative for designing the optimal RT field for AS-HL patients.…”