949P - 30 year results of radiotherapy and СОРР (МОРР) trials in Hodgkin's lymphoma with preventive liver and lung irradiation: The causes of mortality af...

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Lymphomas
Surgery and/or Radiotherapy of Cancer
Presenter Pavel Datsenko
Citation Annals of Oncology (2014) 25 (suppl_4): iv327-iv339. 10.1093/annonc/mdu339
Authors P.V. Datsenko
  • Moscow, Russian Federation, Moscow Herzen Research Oncological Institute, 125284 - Moscow/RU

Abstract

Aim

The aim of this study was to examine long-term results and causes of mortality after treatment of HL with COPP (MOPP) regimens and radiotherapy with or without preventive liver and lung irradiation.

Methods

589 patients with HL stage I – IV were treated with radiotherapy alone (n = 124) and COPP (MOPP) regimens (n = 466) from 1980-2000. After a median observation time of 11 years 103 patients (bulky mediastinal or hilar disease, or spleen involvement; n = 339) treated with prophylactic lung (1-16 Gy) or liver (2-20 Gy) irradiation, 204 patients – standard radiotherapy (median – 6.9 years).

Results

General group (n = 589). HL is the main cause of death over the first 20 years after treatment. By 20 years after therapy, the cumulative mortality from a second malignancy and cardiovascular disease will exceed the cumulative mortality from HL. 165 five deaths (28%) have occurred after treatment HL. The rates for 20-year OS are 56.2%, 30-year – 49.2%. Mortality from second malignancy was 3.7%, cardiovascular disease – 3.6%. Four cases of secondary leukemia (0.7%) and three cases of meningitis have been observed to date, the mortality rate was 100%. Group with risk factors (bulky mediastinal or hilar disease, or spleen involvement; n = 339). The rates for 20-year freedom from treatment failure are 74.9% and 48.2%, respectively (p = 0.000), 20-year OS - 56.2% and 55.6%, respectively (p = 0.544). The rates for 20-year DSS (death from HL) are 79.2% and 63.6%, respectively (p = 0.054). Probability of death from HL, according to logistic regression analysis, in the group with standard radiotherapy was 2.2 times higher (p = 0.027) in comparison with the group with prophylactic irradiation. The rates for 20-year OS (death from complication) were 70.9% and 80.1%, respectively (p = 0.076), risk factors – pneumonitis (p = 0.001) and liver irradiation (p = 0.011); probability of death from complication in the group with liver irradiation at 3.3 time above (p = 0.027). After 20-25 years observation data the mortality rate from complication in group with pneumonitis “RTOG 3-4” was close to 100%.

Conclusions

HL followed by second tumors, cardiac events, and infections remain the major causes of death after treatment for HL. Our findings suggest the importance of both maintaining a high disease-free survival and reducing long-term complications in designing treatments of HL.

Disclosure

All authors have declared no conflicts of interest.