Radiation therapy for early stage unfavorable Hodgkin lymphoma: is dose reduction feasible?
One hundred and fifty-one patients aged between 3 and 70 years with early stage unfavorable Hodgkin lymphoma were included. Patients received 4-6 cycles of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) chemotherapy and involved field radiation therapy (IFRT). The most common histology was mixed cellularity (43%). The majority had stage IIAX disease. IFRT doses were 25.2 Gy/14 fractions and 34.2 Gy/19 fractions for adults with a complete response (CR) and partial response (PR), respectively, while the doses were 19.8 Gy/11 fractions and 30.6 Gy/17 fractions, respectively, for children. After 60 months (median), the 10-year progression-free survival (PFS) and overall survival (OS) were 88.4% and 93.2%, respectively. On univariate analysis, prognostic factors with significant impact on PFS were age ≥ 18 years, nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) histology, extranodal disease and response to treatment. Extranodal disease had a significant impact on OS. On multivariate analysis, NLPHL histology (p = 0.001) and response at 3 months (p = 0.000) had a significant impact on PFS. There were no in-field relapses in patients with bulky disease receiving RT doses > 25.2 Gy. Chemotherapy related acute pulmonary toxicity was documented in 21.4% and 4.8% of patients after six and four cycles of ABVD chemotherapy (p = 0.041). Four cycles of ABVD and reduced dose IFRT resulted in optimal outcomes.
['Laskar|Siddhartha|S|', 'Kumar|Deepak P|DP|', 'Khanna|Nehal|N|', 'Menon|Hari|H|', 'Sengar|Manju|M|', 'Arora|Brijesh|B|', 'Gujral|Sumeet|S|', 'Shet|Tanuja|T|', 'Sridhar|Epari|E|', 'Rangarajan|Venkatesh|V|', 'Muckaden|Mary Ann|MA|', 'Nair|Reena|R|', 'Banavali|Shripad|S|']
D000293:Adolescent D000328:Adult D000368:Aged D000971:Antineoplastic Combined Chemotherapy Protocols D002648:Child D002675:Child, Preschool D005260:Female D005500:Follow-Up Studies D006689:Hodgkin Disease D006801:Humans D008297:Male D008875:Middle Aged D009367:Neoplasm Staging D011379:Prognosis D011829:Radiation Dosage D012189:Retrospective Studies D016896:Treatment Outcome D055815:Young Adult
radiation Hodgkin lymphoma prognostication