For a period of 25 months from 2009 to 2012, 164 evaluable patients under the age of 22 with classic Hodgkin lymphoma in stage 3b (43 percent) and stage 4b (57 percent) were examined. Overall, 84 percent of the patients showed large tumors (bulky disease).
Patients were classified as fast early response or slow early response after receiving two courses of standard combination chemotherapy (doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide) given with radiation therapy. Patients with slow early response were randomized to receive two additional standard combination cycles and two cycles of chemotherapy of ifosfamide and vinorelbine, followed by radiation delivery adapted only to larger tumors or slow-responding sites. Patients with rapid early responders were given two additional standard combination cycles, followed by delivery of customized radiation only to initial large tumors. 76 percent of the patients received radiation therapy. Relapses were characterized in terms of location and radiation field.
At the median follow-up time of 4.5 years, 27 of 145 patients (19 percent) had relapsed and 23 patients were evaluable. Of these 23 patients, 11 were fast early responders and 12 were slow early responders. In the 23 evaluable patients with relapse, there were a total of 105 relapse sites (median = 4, range: 1-11). 64 percent of relapses occurred at an initial location of involvement. Overall, 94 percent of relapses occurred in sites that were initially PET2 negative.
“These results confirm that modern combined modality efforts of chemotherapy and radiation therapy are very effective and produce excellent results in pediatric patients with Hodgkin’s lymphoma,” notes Dr. Parikh, director of the Laurie Proton Therapy Center at Robert Wood Johnson University Hospital, a RWJBarnabas health facility; and Associate Professor of Radiation Oncology at Rutgers Robert Wood Johnson Medical School.
Other investigators working alongside Parikh BS Hoppe, Mayo Clinic Florida; D. Hodgson, Princess Margaret Cancer Center, Toronto; KM McCarten, Brown University; Q. Pei, University of Florida, Gainesville; SY Cho, University of Wisconsin Carbone Cancer Center; C. Schwartz, Wisconsin Medical School; P. Cole, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; KM Kelly, Roswell Park Cancer Institute; and KB Roberts Yale University School of Medicine.
This work was supported in part by grants from the National Institutes of Health Children’s Oncology Group (U10CA098543), Statistics and Data Center Grants (U10CA098413), NCTN Operations Center Grants (U10CA180886), NCTN Statistics and Data Center Grants (U10CA180899) supported. QARC (CA29511) and IROC RI (U24CA180803) und St. Baldrick’s Foundation.
In addition to this work, faculty members at the Rutgers Cancer Institute, including those who care for patients at RWJBarnabas Health facilities, are contributors to a number of other discussions and abstracts / posters published in connection with the ASTRO annual meeting. These presentations include:
Via the Rutgers Cancer Institute in New Jersey
The Rutgers Cancer Institute is the only National Cancer Institute to be designated a Comprehensive Cancer Center by the National Cancer Institute and, together with RWJBarnabas Health, offers the most advanced cancer treatment options including bone marrow transplantation, proton therapy, CAR T-cell therapy, and complex surgery. In addition to clinical trials and novel therapeutics such as precision medicine and immunotherapy – many of which are not widely available – patients have access to these cutting-edge therapies at the Rutgers Cancer Institute in New Jersey in New Brunswick and the Rutgers Cancer Institute in New Jersey at the University Hospital in Newark as well as through RWJBarnabas Health facilities. To make a tax-deductible gift in support of the Cancer Institute of New Jersey call 848-932-8013 or visit www.cinj.org/giving.
About the Pediatric Oncology Group (COG)
COG (childrensoncologygroup.org), a member of the NCI National Clinical Trials Network (NCTN), is the world’s largest organization exclusively dedicated to cancer research in children and adolescents. COG brings together over 10,000 childhood cancer experts in more than 200 leading children’s hospitals, universities and cancer centers in North America, Australia and New Zealand to fight childhood cancer. Today more than 90% of the 14,000 children and adolescents diagnosed with cancer each year in the United States are cared for in COG member institutions. Research carried out by COG facilities for the past 50 years has turned childhood cancer from a virtually incurable disease to a disease with a combined 5-year survival rate of 80%. COG’s mission is to improve the cure rate and outcomes for all children with cancer.
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