Chemotherapy, radiotherapy and combined modality for Hodgkin's disease, with emphasis on second cancer risk

Franklin, Jeremy; Paus, Marcus D; Pluetschow, Annette; Specht, Lena

doi:10.1002/14651858.cd003187.pub2

Cited by 50 publications

(28 citation statements)

References 116 publications

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“…This is in line with the finding that extended field radiotherapy had little or no advantage over involved field radiotherapy in Hodgkin's patients when used alone or after effective chemotherapy. 3,8 In addition, subgroup analyses gave no hint that the hazard ratios may differ depending on the proportion of patients with early favorable or early unfavorable disease or the inclusion or exclusion of patients with bulky disease. However, due to the small number of trials included, reliable information from subgroup analyses is unlikely.…”

Section: Discussionmentioning

confidence: 99%

“…The absolute risk difference between chemotherapy alone and chemotherapy plus radiotherapy in a recent individual patient data meta-analysis was about 1% in early stage patients at 15 years. 8 Cohorts of Hodgkin's patients of any stage suggest that this difference is much higher. 8,[11][12][13][14][15][16][17]39 However, patients who relapse have a more pronounced risk of secondary malignancies according to a cohort study by Aleman and colleagues.…”

Section: Discussionmentioning

confidence: 99%

“…Depending on intensity and dose of treatment, long-term complications such as secondary malignancies, 8 cardiac disease 9 and infertility 10 are common in Hodgkin's survivors. For patients with early stage disease, the 20-year cumulative secondary malignancy rate is estimated between 4% and 20%.…”

Section: Introductionmentioning

confidence: 99%

“…8,11 Risk factors for secondary malignancies and cardiac disease are the choice and dose of chemotherapy and radiotherapy. 8,[11][12][13][14][15][16][17] Unfortunately, long-term comparisons of combined modality treatment with chemotherapy alone (CT-alone) are difficult in cohorts of Hodgkin's survivors. Nonetheless, to avoid additional radiation-induced toxicity, chemotherapy-only treatment for patients with early stage HL has been advocated.…”

Section: Introductionmentioning

confidence: 99%

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Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Herbst¹,

Rehan²,

Brillant³

et al. 2009

Haematologica

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The online version of this article has a supplementary appendix.Combined modality treatment (CMT) of chemotherapy followed by localized radiotherapy is standard treatment for patients with early stage Hodgkin's lymphoma. However, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. We thus performed a systematic review with meta-analysis of randomized controlled trials comparing chemotherapy alone with CMT in patients with early stage Hodgkin's lymphoma with respect to response rate, tumor control and overall survival (OS). We searched Medline, EMBASE and the Cochrane Library as well as conference proceedings from January 1980 to February 2009 for randomized controlled trials comparing chemotherapy alone versus the same chemotherapy regimen plus radiotherapy. Progression free survival and similar outcomes were analyzed together as tumor control. Effect measures used were hazard ratios for OS and tumor control as well as relative risks for complete response (CR). Meta-analyses were performed using RevMan5. Five randomized controlled trials involving 1,245 patients were included. The hazard ratio (HR) was 0.41 (95% confidence interval (CI) 0.25 to 0.66) for tumor control and 0.40 (95% CI 0.27 to 0.59) for OS for patients receiving CMT compared to chemotherapy alone. CR rates were similar between treatment groups. In sensitivity analyses another 6 trials were included that did not fulfill the inclusion criteria of our protocol but were considered relevant to the topic. These trials underlined the results of the main analysis. In conclusion, adding radiotherapy to chemotherapy improves tumor control and OS in patients with early stage Hodgkin's lymphoma.Key words: combined modality treatment, chemotherapy, Hodgkin's lymphoma.Citation: Herbst C, Rehan FA, Brillant C, Bohlius J, Skoetz N, Schulz H, Monsef I, Specht L, and Engert A. Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review. Haematologica. 2010.95:494-500. doi:10.3324/haematol.2009 This is an open-access paper. ABSTRACT therapy.The main objective of this systematic review was to compare chemotherapy alone with identical chemotherapy plus radiotherapy in patients with early stage HL with respect to overall survival, tumor control and complete response rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Herbst¹,

Rehan²,

Brillant³

et al. 2009

Haematologica

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show abstract

“…To reach their conclusions, the experts extensively analyzed large randomized clinical trials conducted in the last 15 years, whose results have been published as full papers [13][14][15][16][17][18][19][20][21] or as abstracts. [22][23][24][25] A number of cohort studies, 3,26,27 and the results of Cochrane analysis on chemotherapy, RT and combined modality for HL 28 have also been considered. For decades, RT has been the standard of care for patients with early stage HL.…”

Section: First-line Therapy For Early Stage Diseasementioning

confidence: 99%

Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

Brusamolino¹,

Bacigalupo²,

Barosi³

et al. 2009

Haematologica

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Chemotherapy alone versus chemotherapy plus radiotherapy for early stage Hodgkin Lymphoma

Rehan¹,

Bohlius²,

Brillant³

et al. 2008

Cochrane Database of Systematic Reviews

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Background Combined modality treatment (CMT) consisting of chemotherapy followed by localised radiotherapy is standard treatment for patients with early stage Hodgkin lymphoma (HL). However, due to long term adverse effects such as secondary malignancies, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. Objectives We performed a systematic review with meta-analysis of randomised controlled trials (RCTs) comparing chemotherapy alone with CMT in patients with early stage Hodgkin lymphoma with respect to response rate, progression-free survival (alternatively tumour control) and overall survival (OS). Search strategy We searched MEDLINE, EMBASE and CENTRAL as well as conference proceedings from January 1980 to November 2010 for randomised controlled trials comparing chemotherapy alone to the same chemotherapy regimen plus radiotherapy. Selection criteria Randomised controlled trials comparing chemotherapy alone with CMT in patients with early stage HL. Trials in which the chemotherapy differed between treatment arms were excluded. Trials with more than 20% of patients in advanced stage were also excluded. Data collection and analysis Effect measures used were hazard ratios (HR) for tumour control and OS as well as relative risks for response rates. Two review authors independently extracted data and assessed quality of trials. We contacted study authors to obtain missing information. Since none of the trials reported progression-free survival according to our definitions, all similar outcomes were evaluated as tumour control. 1 Chemotherapy alone versus chemotherapy plus radiotherapy for early stage Hodgkin lymphoma (Review)

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Chemotherapy, radiotherapy and combined modality for Hodgkin's disease, with emphasis on second cancer risk

Cited by 50 publications

References 116 publications

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

Chemotherapy alone versus chemotherapy plus radiotherapy for early stage Hodgkin Lymphoma

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