Chemotherapy only in early-stage Hodgkin lymphoma: More relapses but “same” (or possibly worse) survival – Reconsidering the misguided trend to omit radiotherapy

Current Hematologic Malignancy Reports

Volumn 9, Issue 3, 2014, Pages 212-216

  Yahalom, Joachim ^a  

^a MEMORIAL SLOAN KETTERING CANCER CENTER   (United States)

Author keywords

Chemotherapy alone; Combined modality therapy; Hodgkin Lymphoma; Involved site radiotherapy (ISRT); Radiotherapy

Indexed keywords

BLEOMYCIN; DACARBAZINE; DOXORUBICIN; VINBLASTINE; ANTINEOPLASTIC AGENT;

CANCER CHEMOTHERAPY; CANCER COMBINATION CHEMOTHERAPY; CANCER RADIOTHERAPY; CANCER RECURRENCE; CANCER STAGING; CANCER SURVIVAL; CLINICAL TRIAL; HODGKIN DISEASE; HUMAN; MULTIMODALITY CANCER THERAPY; MULTIPLE CYCLE TREATMENT; OVERALL SURVIVAL; POSITRON EMISSION TOMOGRAPHY; QUALITY OF LIFE; REVIEW; TREATMENT FAILURE; PATHOLOGY; PROCEDURES; SALVAGE THERAPY;

ANTINEOPLASTIC COMBINED CHEMOTHERAPY PROTOCOLS; BLEOMYCIN; COMBINED MODALITY THERAPY; DACARBAZINE; DOXORUBICIN; HODGKIN DISEASE; HUMANS; POSITRON-EMISSION TOMOGRAPHY; SALVAGE THERAPY; VINBLASTINE;

EID: 84911002931     PISSN: 15588211     EISSN: 1558822X     Source Type: Journal    
DOI: 10.1007/s11899-014-0222-5     Document Type: Review

References (24)

1. Eichenauer DA et al. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2011;22 Suppl 6:vi55–8. ESMO consensus guidelines for diagnosis and treatment of Hodgkin lymphoma.
2. Follows, G.A., et al., Guidelines for the first line management of classical Hodgkin lymphoma. Br J Haematol, 2014. Very recent UK guidelines for HL addressing combined modality and chemotherapy alone.
3. Herbst C et al. Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review. Haematologica. 2010;95(3):494–500.
4. Koshy M et al. Declining use of radiotherapy in stage I and II Hodgkin's disease and its effect on survival and secondary malignancies. Int J Radiat Oncol Biol Phys. 2012;82(2):619–25. Largest US SEER data comparing survival with or without RT.
5. Hoppe, R.T. Hodgkin Lymphoma. 2014 [cited 2014; Available from: http://www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf.
6. Specht L et al. Influence of more extensive radiotherapy and adjuvant chemotherapy on long-term outcome of early-stage Hodgkin's disease: a meta-analysis of 23 randomized trials involving 3,888 patients. International Hodgkin’s Disease Collaborative Group. J Clin Oncol. 1998;16(3):830–43.
7. Press OW et al. Phase III randomized intergroup trial of subtotal lymphoid irradiation versus doxorubicin, vinblastine, and subtotal lymphoid irradiation for stage IA to IIA Hodgkin's disease. J Clin Oncol. 2001;19(22):4238–44.
8. Engert A et al. Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin's lymphoma: results of the HD8 trial of the German Hodgkin's Lymphoma Study Group. J Clin Oncol. 2003;21(19):3601–8.
9. Engert A et al. Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin's lymphoma: final results of the GHSG HD7 trial. J Clin Oncol. 2007;25(23):3495–502.
10. Meyer RM et al. ABVD alone versus radiation-based therapy in limited-stage Hodgkin’s lymphoma. N Engl J Med. 2012;366(5):399–408. A controversial study using extensive radiation fields to demonstarte risk in spite of better disease control with combined modality.
11. Raemaekers JM et al. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2014;32(12):1188–94.
12. Radford, J., et al., Involved field radiotherapy versus no further treatment in patients with clinical stages IA and IIA Hodgkin lymphoma and a ‘negative’ PET scan after 3 cycles ABVD: Results of the UK NCRI RAPID trial, in ASH2012. p. Abstract 547. A study that shows that most carefully analyzed PET negative patients with EHL will have a good disease control with ABVD X3, but still adding RT will improve their outcome by approximately 7 %.
13. Swerdlow AJ et al. Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst. 2007;99(3):206–14.
14. Illidge T. XVII. Radiotherapy in early stage Hodgkin lymphoma. Hematol Oncol. 2013;31 Suppl 1:92–5.
15. Engert A et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med. 2010;363:640–52. The classic large scale GHSG trial allowing safe reduction of both ABD and RT with superb results setting the standard treatment of today.
16. Lund MB et al. Lung function impairment in long-term survivors of Hodgkin's disease. Ann Oncol. 1995;6(5):495–501.
17. Boll B et al. ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol. 2013;31(12):1522–9.
18. Deprez, S., et al., Longitudinal Assessment of Chemotherapy-Induced Alterations in Brain Activation During Multitasking and Its Relation With Cognitive Complaints. J Clin Oncol, 2014. A new objective concern for patients receiving chemotherapy affecting cognitive function.
19. Eich, H.T., et al., Intensified Chemotherapy and Dose-Reduced Involved-Field Radiotherapy in Patients With Early Unfavorable Hodgkin's Lymphoma: Final Analysis of the German Hodgkin Study Group HD11 Trial. J Clin Oncol, 2010. The SHSG large scale trial in unfavorable patients setting the current standard approach.
20. Maraldo MV et al. Involved node radiation therapy: an effective alternative in early-stage hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2013;85(4):1057–65.
21. Specht, L., et al., Modern Radiation Therapy for Hodgkin Lymphoma: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys, 2013. The new guidelines for field and dose reduction. The consensus recomendation of international experts.
22. De Bruin ML et al. Breast cancer risk in female survivors of Hodgkin's lymphoma: lower risk after smaller radiation volumes. J Clin Oncol. 2009;27(26):4239–46.
23. Ng AK et al. Prospective study of the efficacy of breast magnetic resonance imaging and mammographic screening in survivors of Hodgkin lymphoma. J Clin Oncol. 2013;31(18):2282–8.
24. Glanzmann C et al. Cardiac risk after mediastinal irradiation for Hodgkin's disease. Radiother Oncol. 1998;46(1):51–62.