Pediatric Hodgkin's lymphoma: trade-offs between short and long-term mortality risks
A partir d'un modèle de simulation, cette étude évalue l'intérêt d'ajouter une radiothérapie à une chimiothérapie pour améliorer la survie globale à long terme des patients pédiatriques atteints d'un lymphome hodgkinien
As pediatric Hodgkin's Lymphoma (HL) survival rates approach >95%, treatment decisions are increasingly based upon minimizing late-effects. Using a model-based approach, we explored whether the addition of radiotherapy contributes to improved overall long-term survival. We developed a state-transition model to simulate the lifetime HL clinical course, and compared two treatment strategies: chemotherapy alone (CT) and chemoradiotherapy (CRT). Data on HL relapse, late-recurrence, and excess second cancer and cardiac late-effects mortality were estimated from published literature and databases. Outcomes included conditional life-expectancy (LE), cause-specific mortality, and proportion alive at age 50. For a hypothetical cohort of HL patients (diagnosis age 15), conditional LE was 57.2 years with CT compared to 56.4 years with CRT. Estimated lifetime HL mortality risk was 3.6% with CT versus 2.2% with CRT. In contrast, combined risk of excess late-effects mortality was lower for CT (1.8% vs. 7.4% with CRT). Among those alive at age 50, only 9.2% of those initially treated with CT were at risk for radiation-related late-effects (100% for CRT). Initial treatment with chemotherapy alone may be associated with longer average per-person life expectancy. These results support the need for careful consideration of the risk-benefit profile of radiation as frontline therapy in pediatric patients.
Blood 2012