The Role of Radiation in All Stages of Nodular Lymphocytic Predominant Hodgkin Lymphoma.
BACKGROUND
The goal of this study was to assess the survival differences seen in early-stage and advanced-stage nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) based on treatment modality.


PATIENTS AND METHODS
The National Cancer Database was queried to identify patients diagnosed with NLPHL between 2004 and 2012. Overall survival (OS) was determined using univariate and multivariate Cox regression analysis. Kaplan-Meier and log-rank analysis were used to estimate differences in OS between treatment groups.


RESULTS
A total of 1968 patients were identified for analysis, consisting of stage I (40.4%), stage II (29.3%), stage III (22.3%), and stage IV (8.0%) disease. The median age of patients was 46 years. The following factors were predictive of radiotherapy (RT) omission in treatment: increasing age, black race, Medicare insurance, chemotherapy use, stage II to IV disease, and the presence of B-symptoms. On survival analysis, RT was associated with prolonged OS in all stages of NLPHL (50.1 vs. 42.4 months; P < .01). The OS benefit of RT persisted on multivariate analysis (hazard ratio, 0.37; P < .01). On subset analysis, RT was associated with prolonged OS in early disease (49.8 vs. 45.5 months; P < .01), whereas a trend towards an OS benefit was observed in advanced-stage (54.1 vs. 39.6 months; P = .06) NLPHL. Radiotherapy was also associated with prolonged OS among patients with B-symptoms (49.0 vs. 42.6 months; P < .01).


CONCLUSION
The use of RT in NLPHL is less likely among those with advanced-stage disease and B-symptoms. However, we found RT to be associated with prolonged OS in all stages of NLPHL, including those with B-symptoms.
['Odei|Bismarck|B|', 'Boothe|Dustin|D|', 'Frandsen|Jonathan|J|', 'Poppe|Matthew M|MM|', 'Gaffney|David K|DK|']
D000293:Adolescent D000328:Adult D000368:Aged D006689:Hodgkin Disease D006801:Humans D053208:Kaplan-Meier Estimate D015451:Leukemia, Lymphocytic, Chronic, B-Cell D016015:Logistic Models D008875:Middle Aged D015999:Multivariate Analysis D009367:Neoplasm Staging D017063:Outcome Assessment, Health Care D016016:Proportional Hazards Models D055815:Young Adult
Radiation Lymphoma Advanced stage B symptoms Definitive