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
Surgical oncology
Therapy
Radiation oncology
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.