Long term effects of consolidative radiotherapy in Hodgkin’s Lymphoma patients at Single institution

Introduction Radiotherapy (XRT) has historically played an important role in cure of patient with Hodgkin’s Lymphoma (HL). However, the occurrence of late adverse treatment effects effect the life expectancy and quality of life in HL survivors. Common late effects include second and subsequent malignant neoplasms (SMNs), several cardiovascular diseases (CVDs), thyroid dysfunction, sub-fertility, premature menopause, and fatigue. The aim of our study is to determine the long-term side effects of consolidative radiotherapy (XRT) in Paediatric Hodgkin lymphoma patients

Methods Medical records from January 2009 to December 2014 retrospectively reviewed after IRB approval. Data collected for patients diagnosed with Hodgkin’s lymphoma at Shaukat Khanum Cancer Hospital, who had received consolidative radiotherapy as part of their treatment and looked at their the long-term side effects till January 2019.

Results Out of 749 patient, 117 (15.6%) were included who had radiotherapy as part of treatment. Low stage disease in 30 patients (26%) and 87 (74%) had advance stage. 36 patients (31%) treated with OEPA/COPP chemotherapy, 10 (8.5%) with CHLVPP/ABVD, 50 (43%) with COPDac/ABVD and 21 (18%) treated on other chemotherapy protocols. Mid-assessment scans showed 65% in partial remission, 33% in complete remission and 2% had disease progression. The most common site of XRT was neck and chest in 68 (58%) of patients followed by abdomen in 34 (29%) and skeletal in 15 (13%). 64 patients (55%) received less than 15 Gy radiations, 38 patients (32.5%) received 15-20 Gy radiations and 15 patients (13%) received more than 20 Gy radiations. Outcomes at end of consolidative XRT was complete remission in 99 patients (85%), 13 (11%) relapsed and in 5 patients disease progressed. Most common long-term side effect was hypothyroidism in 11 patients (9%) followed by hypogonadism in 2 patients likely due to Procarbazine. One patient had mild cardiotoxicity with Doxorubicin and recovered his cardiac functions with anti-failure meds. All 14 patients with late effects are alive and in remission until last follow up.

Conclusion Our analysis showed less long terms effects in patients as outcomes have improved with chemotherapy alone. However, those who develop them needs to be monitored closely. Patients who had complete remission at mid-assessment do not need to have radiotherapy

• References

• 1 van Leeuwen Flora E, Ng Andrea K. 2016; . Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment. Hematology ASH Education Book. December 2, 2016 vol. 2016 no. [phone] .
• 2 Gonzalez Victor J. ( 2017; ). Role of Radiation Therapy in the Treatment of Hodgkin Lymphoma. Curr Hematol Malig Rep 12: 244-250 .