COST‐EFFECTIVENESS AND COST‐UTILITY ANALYSIS OF MULTIPLE TREATMENT STRATEGIES USING ABVD AND/OR BEACOPP IN THE TREATMENT OF ADVANCED‐STAGE HODGKIN LYMPHOMA
Notice bibliographique
Résumé
Introduction: Consolidation Radiotherapy (cRT) was originally proposed for ABVD-treated advanced stage Hodgkin Lymphoma (aHL) presenting with bulky or a residual mass (RM) after ABVD.However, very few published data exist on the role of cRT on RM in patients (pts) with a negative end-of treatment PET (EoT-PET) after ABVD.Methods: In the HD0607 clinical trial (Gallamini JCO 2018) aHL pts (stage IIB-IVB) were treated with 2 ABVD courses, followed by an interim PET (PET-2).PET-2 positive pts were randomized to 4 BEACOPP escalated + 4 BEACOPP baseline cycles ± rituximab before each cycle.PET-2 negative pts were treated with 4 more ABVD and a EoT-PET was performed afterwards.PET-2 and EoT-PET negative pts were randomized to either cRT on the sites where a large nodal mass (LNM) was detected at baseline, or no further therapy (NFT).LNM was defined as single or a conglomerated nodal mass with the largest diameter ≥ 5 cm in baseline CT.Results: After ABVD, 47/630 (7%) PET2 negative pts with a positive EoT-PET, 27/630 off study pts for disease progression or consent withdrawal and 260 pts without LNM were not suitable for the random, while 296 were randomized to cRT (148) or NFT (148).In this pts cohort the largest diameter of LNM was 5-7 cm in101 (34%) 8-10 cm in 96 (32%), while a classical bulky (diameter >10 cm) was detected in 99 (33%) pts.Prognostic factors, age, sex, stage, IPS, Performance status, extra-nodal sites, bulky disease were well balanced between the two cohorts.In pts presenting with one (265) or more (31) LNM, the most common nodal region was mediastinum (82%), followed by cervical (14%), abdominal (6%) or axillary (3%) regions.A post-ABVD RM was detected in 260 (88%) of 296 pts presenting with a LNM and in 92/99 pts with classical bulky.The median dose of RT was 30.6 (24.0-113.6)Gy, by involved field (88%) involved node (1%) or involved site (11%) technique.After a median follow-up of 5.9 (0.5-10) years the 6-year PFS for RT versus NFT in an intention to treat analysis was 92% (95% CI, 88-97%) versus 90% (95% CI, 85-95%) p = .48(Figure ) and a 6-year OS 99% (95% CI, 97-100%) versus 98% (95% CI, 96-100%), respectively.When the analysis was limited to patients with a classical bulky lesion, the 6-year PFS was 89% (95% CI, 81-99%) for consolidation RT and 86% (95% CI, 77-96%) for NFT (p = .53).The 6-year PFS of the 260 non-randomized pts without LNM at baseline, was 92% (95% CI, 88-95%).When the analysis was limited to those with RM, the relapse rate of patients treated or not with cRT was 7% versus 9%, with a 6-year PFS of 93% (95% CI, 88% to 97%) versus 89% (95% CI, 84% to 95%) (P = .41).Conclusions: cRT could be safely omitted in aHL pts presenting with a LNM and both a negative PET-2 and EoT-PET, irrespective from the LNM size.As in more than 80% of the pts the site of LNM at baseline was in mediastinum, this could translate in a significant reduction of late-onset treatment related mortality for secondary tumours and coronary arterial disease.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,021 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,006 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».