Extended field radiotherapy, combined modality treatment or involved field radiotherapy for patients with stage IA lymphocyte-predominant Hodgkin's lymphoma: a retrospective analysis from the German Hodgkin Study Group (GHSG)

Abstract

In terms of remission induction IF radiotherapy for stage IA LPHL patients is as effective as EF or CM treatment. However, longer follow-up is needed before final conclusion as the optimal therapy.

Biology, Clinical Course and Management of Nodular Lymphocyte-Predominant Hodgkin Lymphoma

“…As a result, treatment of early favorable NLPHL stages is heterogeneous including extended and involved-field radiation, combined modality treatment and more recently monoclonal antibodies. [32][33][34][35][36] Pediatric study groups reported nonrandomized case studies of NLPHL with small numbers of patients, 37,38 suggesting that a watch-and-wait strategy after initial lymph node surgery may be an appropriate treatment. Pellegrino et al retrospectively analyzed 27 children (median age 10 years), most of whom had localized NLPHL who received either standard treatment or were not treated beyond initial lymphadenectomy.…”

“…However, longer follow-up is needed before final conclusions can be drawn regarding the optimal therapy in this series. 34 After their H7 trial (1998-93), the EORTC has also adopted IF radiotherapy as standard treatment for stage IA NLPHL. 39 …”

Advances in the treatment of Hodgkin lymphoma

“…When compared with classical HL (cHL), NLPHL is characterized by a more indolent clinical course often resembling indolent B cell non-Hodgkin lymphoma (NHL) and a substantially different immunophenotype with consistent positivity for CD20 [31,32]. Due to its mostly indolent clinical course, the standard treatment for early favorable NLPHL recommended by most cooperative groups consists of RT alone [33,34]. Results with this approach are excellent with remission rates close to 100 % and longterm survival in about 95 % [35].…”

Treatment of Early Stage Hodgkin Lymphoma

“…The extremely favorable prognosis on some cases is reflected by data which showed that patients with stage IA may be treated with LN excision followed by a "watch and wait" approach or with IFRT alone (Diehl, Sextro, Franklin, et al, 1999;Nogova, Reineke, Eich, et al, 2005;Wilder, Schlembach, Jones, et al, 2002;Wirth, Yuen, Barton, et al, 2005) and that some patients with Stages IIIA-IVA may benefit as well from the "watch and wait" approach until they become symptomatic without jeopadarizing treatment outcomes.…”

“…Nogova L et al (Nogova, Reineke, Eich, et al, 2005) reported a retrospective analysis, from the GHSG, which included 131 patients with stage IA NLPHL treated with either IF-RT alone (45 patients), ER-FT alone (45 patients), or the RT combined with two to four cycles of ABVD chemotherapy (41 patients). At a median follow-up of 78 months for EF-RT, 17 months for the IF-RT, and 40 months for the combined modality, the estimated 24-month FFTF rates were 100, 92, and 97 percent, respectively for the three treatment groups.…”