Bulking down.

Top Line: Do patients with advanced Hodgkin lymphoma benefit from consolidative radiation if they have a negative interim PET?

The Study: Patients with initially large nodal masses from HL will likely have a measurable lesion after treatment regardless of the extent of their response. The challenge is that not all residual masses harbor residual disease. The GITIL/FIL HD 0607 trial included nearly 800 patients with advanced HL (stage IIB-IVB) and looked at different treatment strategies based on PET/CT after 2 cycles of ABVD (PET-2). One of the study questions was whether patients with large nodal masses (5+ cm) but a negative PET-2 benefited from radiation to the site of bulky disease. Overall, 80% of patients had a negative PET-2 (Deauville 1-3) and received a total of 6 cycles ABVD. Nearly 300 of those presented with a large nodal mass. They were randomized to receive no further treatment or radiation (30 Gy). An important side note here is that there was no formal statistical design to define superiority of the RT arm. Nevertheless, at 6 years, there was no significant difference in the rate of progression-free survival with (92%) or without (90%) RT. Likewise, there were no major differences in disease free or overall survival. Subsets of patients with measurable residual masses (on CT), classical bulky disease (10+ cm), and Deauville 3 disease had interesting numerical differences, but there were still no significant differences in outcome. Due to the limited number of events, it's hard to draw strong conclusions about patterns of failure +/- RT. 

TBL: In patients with advanced HL and a large nodal mass, a Deauville 1-3 PET/CT after 2 cycles of ABVD is prognostic of favorable treatment outcomes and little to no additional benefit from consolidative radiation. | Gallamini, J Clin Oncol 2020