Patterns of relapse and long-term outcome in patients treated with a curative intent for advanced Hodgkin lymphoma

Consolidation radiotherapy for advanced Hodgkin lymphoma (AHL) is controversial. Precise knowledge of the most likely relapse location is crucial for radiotherapy planning. We performed detailed patterns of relapse analyses and evaluated if initial bulky disease, initial 18F-fluoro-deoxy-glucose (FDG)-avidity and/or a residual mass on computed tomography (CT)-scan after chemotherapy are sites with a high risk of relapse. This information could provide guidance for optimal use of radiotherapy in AHL.
We included 133 patients treated with curatively intended chemotherapy for AHL. 23 patients received consolidation radiotherapy. For relapsed patients, imaging from diagnosis, response evaluation, relapse, and any radiotherapy planning, were retrieved and co-registered to determine the exact site(s) of relapse relative to initial site(s), residual mass(es) and to any irradiated volumes. Size and FDG-avidity of initial sites with later relapse, and residual CT-abnormalities after chemotherapy in these sites were registered. Survival analyses were done using the Kaplan–Meier method.
Nine (6.8%) patients relapsed, eight in initially involved sites. One relapse was in an initially irradiated site (as well as other sites). Initial bulky disease, high initial FDG-uptake, and/or residual masses on CT-scan after chemotherapy did not predict sites with a high risk of relapse. Overall survival was 79.6% (95% CI, 72.7–86.5%) and 70.6% (95% CI, 62.4–78.8%) at 5 and 10 years, respectively. Time to progression analysis showed 91.8% (95% CI, 86.9–96.7%) and 90.7% (95% CI, 85.4–96.0%) without progression at 5 and 10 years, respectively.
Current treatment strategies for AHL provide excellent disease control. Neither initial bulk, high initial FDG-uptake, nor a residual CT-abnormality post-chemotherapy seem to indicate sites with a high risk of relapse.

晚期霍奇金淋巴瘤（advanced Hodgkin lymphoma, AHL）的巩固放疗尚存争议。精准掌握最可能的复发部位，对放疗规划至关重要。本研究开展了详细的复发模式分析，并评估了初始大肿块病变、初始18F-氟代脱氧葡萄糖（18F-fluoro-deoxy-glucose, FDG）摄取活性，以及化疗后计算机断层扫描（computed tomography, CT）检出的残留病灶，是否属于高复发风险部位。上述研究结果可为晚期霍奇金淋巴瘤放疗的优化应用提供指导。
本研究纳入133例接受根治性化疗的晚期霍奇金淋巴瘤患者，其中23例接受了巩固放疗。对于复发患者，我们调取了其诊断、疗效评估、复发及任何放疗规划阶段的影像学资料，并进行配准，以明确复发的精确部位与初始病灶、残留病灶及既往照射野的相对位置。同时记录了后续出现复发的初始病灶的大小及FDG摄取活性，以及这些部位化疗后CT检出的异常残留情况。生存分析采用卡普兰-迈耶法（Kaplan–Meier）进行。
共有9例（6.8%）患者复发，其中8例复发于初始受累部位，1例复发于既往照射过的部位（同时累及其他部位）。初始大肿块病变、初始高FDG摄取活性，以及化疗后CT检出的残留病灶，均无法预测高复发风险部位。患者的5年总生存率为79.6%（95%置信区间，72.7%~86.5%），10年总生存率为70.6%（95%置信区间，62.4%~78.8%）。至疾病进展时间分析显示，患者5年无进展率为91.8%（95%置信区间，86.9%~96.7%），10年无进展率为90.7%（95%置信区间，85.4%~96.0%）。
当前晚期霍奇金淋巴瘤的治疗策略可实现优异的疾病控制效果。初始大肿块病变、初始高FDG摄取活性，以及化疗后CT检出的残留异常，均未提示存在高复发风险的部位。