MANAGEMENT'AND'PROGNOSTIC'VALUE'OF'RESIDUAL'MASSES'DURING'
POSTER'30'
HODGKIN'LYMPHOMA'TREATMENT'
'
Raoudha!Mansouri1,!Karima!Kacem1,!Dorra!Jabr1,!Tarek!Ben!Ahmed2,!Rimel!Kanoun1,!Emna!Barred1,!
Meriem!Achour1,!Salma!Kefi1,!Manel!Bchir1,!Rachid!Kharrat1,!Marwa!Bahri1,!Hend!Ben!Neji1,!Yosr!Ben!
Abdennebi1,!Raihane!Ben!Lakhal1,!Lamia!Aissaoui1!and!Balkis!Meddeb1!
!!
(1)Aziza!Othmana!Hospital,!TUNIS,!Tunisia,!(2)Farhad!Hached!Hospital,!Sousse,!Tunisia!
!
Introduction:'!
The!management!of!the!residual!mass!during!the!Hodgkin!lymphoma!(HL)!treatment!is!a!real!
therapeutic!problem!due!to!the!assessment!difficulty.!We!propose!in!this!work!to!specify!the!
practical! approach! in! the! face! of! a! residual! mass! and! to! study! its! prognostic! impact! on!
relapseJfree!survival!(RFS),!overall!survival!(OS)!and!eventJfree!survival!(EFS).!
Patients'and'methods:'!
Among! 146! patients! followed! and! treated! for! classic! HL! in! the! clinical! hematology!
department!of!Aziza!Othmana!hospital,!103!patients!were!included!in!therapeutic!group!3!of!
the!national!protocol!MDH15!(age!less!than!60!years!with!an!extended!stage!or!a!localized!
stage!with!large!mediastinal!mass).!The!median!age!was!31!years!15J59!years!with!a!sex!
ratio!of!1.16.!SeventyJseven!patients!(75%)!had!extensive!stages!and!26!patients!(25%)!had!
localized!stages!with!a!large!mediastinal!mass.!An!MTI>!0.35!was!noted!in!37!patients,!i.e.!
36%.!The!bulky!affected!25%!of!cases.!At!the!end!of!treatment,!a!response!≥75%!was!noted!
in!78%!of!patients.!
Results:'!
At! the! end! of! treatment,! 44! patients! kept! a! residual! mass! (i.e.! 49%).! The! location! was!
predominantly!mediastinal!(34%).!21!patients!had!a!PET!(47%!of!cases).!It!was!negative!in!15!
patients!and!positive!in!6!patients.!Four!had!whole!body!functional!MRI.!It!was!negative.!A!
biopsy! of! the! residual! mass! was! performed! in! 4! patients! and! was! negative! in! all! cases.!
Complementary! radiotherapy! (RT)! to! the! residual! sites! was! indicated! in! 7! patients! and!
abstention!was!recommended!in!8!patients!(residual!mass!<3cm).!In!univariate!analysis,!no!
prognostic!value!of!the!residual!mass!was!observed!for!OS!(p!=!0.62),!EFS!(p!=!0.62)!and!RFS!
(0.89).!Likewise,!radiotherapy!to!residual!sites!did!not!influence!OS!(p!=!0.47),!EFS!(p!=!0.4)!
and!RFS!(0.48).!A!complete!metabolic!response!(DS≤3)!is!associated!with!a!better!OS!and!RFS!
of!100%!vs.!80%!and!87.4%,!respectively.!The!EFS!is!better!if!the!PET!is!negative!(p!=!0.03)!
Conclusion:'!
The!prognostic!value!of!the!PET!scan!makes!the!management!of!residual!masses!possible.!
Radiotherapy!of!the!residual!masses!does!not!seem!to!modify!survival.!
! !