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Quality control of involved-field radiotherapy for patients with early stage Hodgkin’s lymphoma based on a central prospective review

Comparison of the results between two study generations of the German Hodgkin Study Group

Qualitätskontrolle der Involved-field-Radiotherapie für Patienten im frühen Hodgkin-Lymphom-Stadium anhand eines zentralen prospektiven Reviews

Vergleich der Ergebnisse zweier Studiengenerationen der „German Hodgkin Study Group“

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Abstract

Purpose

Based on experience in trials HD10 and HD11 (1998–2003), the radiotherapy reference center of the German Hodgkin Study Group (GHSG) continued their central prospective radiation oncological review in trials HD13 and HD14. The purpose of this analysis was to identify the impact of this procedure on radiotherapeutic management and to compare findings with former trials.

Methods

Between 2003 and 2009, 1,710 patients were enrolled in the HD13 trial (early favorable stages) and 2,039 patients in the HD14 trial (early unfavorable stages). All patients received a total of 30 Gy involved-field (IF) radiotherapy within a combined modality approach.

Results

For patients in HD13, there was a correction of disease involvement in 847/1,518 patients (56%), and for patients in HD14 in 1,370/1,905 patients (72%). Most discrepancies were observed in the lower mediastinum (19.2%), infraclavicular (31.7%), upper cervical (12.7%), and supraclavicular (10.8%) lymph nodes. This resulted in a change of disease stage in 241 (7%) patients and a shift into another study protocol in 66 (2%) patients. Due to the incorrect lymph node documentation of the participating study centers, the IF radiotherapy volume had to be enlarged in 1,063/3,423 patients (31%) and reduced in 244/3,423 patients (7.1%). These findings are comparable to the results of the quality control in the trials HD10 and HD11 (2,611 patients reviewed).

Conclusion

Central review of the diagnostic imaging and clinical findings of Hodgkin’s lymphoma patients shows a considerable number of discrepancies compared with the local evaluation. Thus, meticulous evaluation of all imaging information in close collaboration between the radiation oncologist and diagnostic radiologist is mandatory.

Zusammenfassung

Einleitung

Aufgrund der Ergebnisse der HD10/11-Studie (1998–2003) führte das radiotherapeutische Referenzzentrum der GHSG („German Hodgkin Study Group“) das zentrale, prospektive Review in den Studien HD13/14 fort. Ziel dieser Auswertung war es, den Stellenwert dieses Vorgehens zu überprüfen und die Ergebnisse mit früheren Auswertungen zu vergleichen.

Methoden

Zwischen 2003 und 2009 wurden insgesamt 1710 Patienten in frühen Stadien (HD13) und 2039 Patienten in intermediären Stadien (HD14) eines Hodgkin-Lymphoms ausgewertet. Alle Patienten erhielten eine Polychemotherapie gefolgt von einer Involved-field-Radiotherapie (IF-RT) mit 30 Gy.

Ergebnisse

In HD13 wurde bei 56% der Patienten (847/1518 Patienten) und in HD14 bei 72% der Patienten (1370/1905 Patienten) eine Änderung des auswärtig dokumentierten Befallsmusters gesehen. Die meisten Änderungen wurden im unteren Mediastinum (19,2%), in infraklavikulären (31,7%), hochzervikalen (12,7%) und supraklavikulären Lymphknoten (10,8%; Fig. 2) beobachtet. Insgesamt 241 Patienten (7%) wiesen demnach ein anderes Stadium auf und 66 Patienten (2%) mussten nach einem anderen Protokoll behandelt werden. Aufgrund der fehlerhaften Lymphknotendokumentation wurde das IF-RT-Volumen für 1063/3423 Patienten (31%) vergrößert und für 244/3423 Patienten (7,1%) verkleinert (Tab. 1). Diese Ergebnisse sind vergleichbar mit den Ergebnissen der Qualitätsanalyse in den Studien HD10 und HD11 (2611 Patienten).

Schlussfolgerung

Eine zentrale Begutachtung der gesamten Bildgebung von Patienten mit einem Hodgkin-Lymphom konnte erhebliche Korrekturen des auswärts dokumentierten Befallsmusters aufdecken. Radioonkologen und diagnostische Radiologen sollten bei der Interpretation der diagnostischen Bilder eng zusammenarbeiten.

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References

  1. Duehmke E, Franklin J, Pfreundschuh M et al (2001) Low-dose radiation is sufficient for the noninvolved extended-field treatment in favorable early-stage Hodgkin’s disease: long-term results of a randomized trial of radiotherapy alone. J Clin Oncol 19(11):2905–2914

    Google Scholar 

  2. Lister TA, Crowther D, Sutcliffe SB et al (1989) Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 7(11):1630–1636

    PubMed  CAS  Google Scholar 

  3. Mendenhall NP (1996) Diagnostic procedures and guidelines for the evaluation and follow-up of Hodgkin’s disease. Semin Radiat Oncol 6(3):131–145

    Article  PubMed  Google Scholar 

  4. Staar S, Müller RP, Diehl V et al (2001) The value of prospective radiotherapy treatment planning in the multicentric German Hodgkin’s Lymphoma Study Group. Int J Radiat Oncol Biol Phys 51(3):70–71

    Article  Google Scholar 

  5. Momm F, Jooß D, Xander C et al (2011) Erfassung möglicher Verbesserungen im Ablauf der Strahlentherapie – eine Patientenbefragung. Strahlenther Onkol 187(11):750–756

    Article  PubMed  Google Scholar 

  6. Eich HT, Staar S, Gossmann A et al (2004) Centralized radiation oncologic review of cross-sectional imaging of Hodgkin’s disease leads to significant changes in required involved field-results of a quality assurance program of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 58(4):1121–1127

    Article  PubMed  Google Scholar 

  7. Fletcher BD, Glicksman AS, Gieser P (1999) Interobserver variability in the detection of cervical-thoracic Hodgkin’s disease by computed tomography. J Clin Oncol 17(7):2153–2159

    PubMed  CAS  Google Scholar 

  8. Dieckmann K, Pötter R, Wagner W et al (2002) Up-front centralized data review and individual treatment proposals in a multicenter pediatric Hodgkin’s disease trial with 71 participating hospitals: the experience of the German-Austrian pediatric multicenter trial DAL-HD-90. Radiother Oncol 62:191–200

    Article  PubMed  Google Scholar 

  9. Loughrey CJ, Carrington BM, Anderson H et al (1999) The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol 54:149–154

    Article  PubMed  CAS  Google Scholar 

  10. Heinzelmann F, Engenhard M, Ottinger H et al (2010) Nodular follicular lymphoma – the role of radiotherapy. Strahlenther Onkol 186(4):191–196

    Article  PubMed  Google Scholar 

  11. Hricak H, Kalbhen CL, Scheidler JE et al (1997) Value of expert interpretation in abdominal oncologic imaging: a multicentre study. Radiological Society of North America. Scientific Programme 205:225

    Google Scholar 

  12. Sauer M, Volz S, Hall M et al (2010) Automatisierte Leistungsübermittlung in der Starhlenheilkunde. Strahlenther Onkol 186(7):396–400

    Article  PubMed  Google Scholar 

  13. Eich HT, Müller R-P, Engenhart-Cabillic R et al (2008) Involved node radiotherapy in early-stage Hodgkin’s lymphoma – definition and guidelines of the German Hodgkin Study Group (GHSG). Strahlenther Onkol 184(8):406–410

    Article  PubMed  Google Scholar 

  14. Eich HT, Engenhart-Cabillic R, Hansemann K et al (2008) Quality control of involved field radiotherapy in patients with early-favorable (HD10) and early-unfavorable (HD11) Hodgkin’s lymphoma: an analysis of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 71(5):1419–1429

    Article  PubMed  Google Scholar 

  15. Fotina I, Lütgendort-Caucig C, Stock M et al (2012) Critical discussion of evaluation parameters for inter-observer variability in target definition for radiation therapy. Strahlenther Onkol 188(1):160–167

    Article  PubMed  CAS  Google Scholar 

  16. Brualla L, Palanco-Zamora R, Steuhl K et al (2011) Monte Carlo simulations applied to conjunctival lymphoma radiotherapy treatment. Strahlenther Onkol 187(8):492–498

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1A, 48419, Muenster, Germany

    J. Kriz, U. Haverkamp & H.T. Eich

  2. Department of Radiology, University of Cologne, Cologne, Germany

    C. Bangard

  3. Department of Radiation Oncology, University of Cologne, Cologne, Germany

    R. Bongartz, C. Baues & R.-P. Mueller

  4. Department of Medical Oncology, University of Cologne, Cologne, Germany

    A. Engert

Authors
  1. J. Kriz
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  2. C. Bangard
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  3. U. Haverkamp
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  4. R. Bongartz
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  5. C. Baues
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  6. A. Engert
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  7. R.-P. Mueller
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  8. H.T. Eich
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Corresponding author

Correspondence to H.T. Eich.

Additional information

Presented at the 52nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology, San Diego, CA, 31 October – 4 November 2010.

Funded by the “Competence Network Malignant Lymphoma” Federal German Ministry of Education and Research and the “Deutsche Krebshilfe.”

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Kriz, J., Bangard, C., Haverkamp, U. et al. Quality control of involved-field radiotherapy for patients with early stage Hodgkin’s lymphoma based on a central prospective review. Strahlenther Onkol 188, 660–665 (2012). https://doi.org/10.1007/s00066-012-0103-6

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  • DOI: https://doi.org/10.1007/s00066-012-0103-6

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