Supplements are necessary
The authors achieved a very good overview of the possible applications for positron emission tomography-computed tomography (PET-CT) (1).
The authors write: “As part of the HD15 study by the German Hodgkin Study Group (GHSG), it was [...] examined whether radiation should be limited to patients who still have PET-positive residual findings after chemotherapy has been completed. Even without subsequent radiation therapy, patients with PET-negative residual lymphomas had a comparable prognosis to patients who achieved a complete remission on CT. "
Additions are required for this. The HD15 study (2) examined patients in advanced stages who had a significantly poorer prognosis and who received six to eight courses of polychemotherapy (BEACOPP) as standard. The patients who subsequently still have PET-positive results have a significantly poorer progression-free survival compared to the PET-negative patients (86.2% versus 92.6% after four years), which justifies the use of radiotherapy.
For all other stages, consolidating radiation after chemotherapy is standard, which, according to the results of the HD-10 and -11 studies of the GHSG, is chosen as low as possible in terms of field size and dose without jeopardizing the success of the therapy. Studies that avoided radiation in favor of intensified chemotherapy, such as the British RAPID trial (3, 4), recorded significantly more disease progression with these experimental approaches, which led to the premature termination of the corresponding therapy arms.
The last GHSG studies (HD16–17) again evaluated the importance of PET in the early stages for therapy stratification by escalating in the experimental arm in the case of PET-negative results after completion of chemotherapy (2 * ABVD or 2 * BEACOPP / 2 * ABVD) did not provide for subsequent radiotherapy. A renunciation of radiotherapy treatment is only permitted in clinical studies or for the advanced stages (analogous to the HD-15 study).
DOI: 10.3238 / arztebl.2018.0417a
Dr. med. Michael Oertel
Prof. Dr. med. Hans-Theodor Eich
Radiation Therapy Clinic -
Radiation Oncology, Münster University Hospital
Conflict of interest
The authors declare that they have no conflict of interest.
|1.||Derlin T, Grünwald V, Steinbach J, Wester HJ, Ross TL: Molecular imaging in oncology using positron emission tomography (PET). Dtsch Arztebl Int 2018; 115: 175-81 FULL TEXT|
|2.||Engert A, Haverkamp H, Kobe C, et al .: Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomized, open-label, phase 3 non-inferiority trial. Lancet 2012; 379: 1791-9 Cross Ref|
|3.||Radford J, Illidge T, Counsel N, et al .: Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med 2015; 372: 1598-607 CrossRefMEDLINE|
|4.||Raemaekers JM, André MP, Federico M, et al .: Omitting radiotherapy in early positron emission tomography-negative stage I / II Hodgkin lymphoma is associated with an increased risk of early relapse: clinical results of the preplanned interim analysis of the randomized EORTC / LYSA / FIL H10 trial. J Clin Oncol 2014; 32: 1188-94 CrossRefMEDLINE|
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