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

Engert, Andreas; Schiller, Petra; Josting, Andreas; Herrmann, Richard; Koch, P.; Sieber, M.; Boissevain, F.; Wit, Maike de; Mezger, J.; Dühmke, Eckhart; Willich, Normann; Müller, Rolf-Peter; Schmidt, Bernhard; Renner, H; Müller‐Hermelink, Hans Konrad; Pfistner, Beate; Wolf, Jürgen; Hasenclever, Dirk; Löffler, Markus; Diehl, Volker

doi:10.1200/jco.2003.03.023

Cited by 415 publications

(197 citation statements)

References 24 publications

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“…These findings were later confirmed by other authors (10,18,19) and the combined modality of chemotherapy plus involved-field radiotherapy has become the goldstandard treatment for low-risk HL, even for those with unfavorable risk factors. Some groups (20,21) began to defend the use of chemotherapy alone to treat HD, especially for patients with localized disease, arguing that: 1) treatment with this pure modality can be used in developing countries where there is no equipment or trained personnel for appropriate irradiation; 2) precise surgical or clinical staging would not be essential; 3) late complications in growth and second malignancy associated with radiotherapy would be avoided.…”

Section: Discussionsupporting

confidence: 58%

Linfoma de Hodgkin na infância e adolescência: 15 anos de experiência com o protocolo DH-II-90

Souza

Maluf

Almeida³

et al. 2010

Rev. Bras. Hematol. Hemoter.

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Section: Discussionsupporting

confidence: 58%

Linfoma de Hodgkin na infância e adolescência: 15 anos de experiência com o protocolo DH-II-90

Souza

Maluf

Almeida³

et al. 2010

Rev. Bras. Hematol. Hemoter.

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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%

“…1,2 The cure rate of patients with early stage disease is high when treated with two to six cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by involved field radiotherapy. [3][4][5] While consolidation radiotherapy is part of treatment for patients with early stage Hodgkin's lymphoma in the ESMO clinical recommendations, 6 the NCCN guidelines 7 consider chemotherapy alone an alternative treatment option.…”

Section: Introductionmentioning

confidence: 99%

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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“…44 Reductions in radiotherapy field sizes and treatment doses for HL and NHL have been made to address the known increased risks for second cancers and cardiac complications caused by radiotherapy. [45][46][47] It is only very recently, however, that epidemiology studies have shown associations between mesothelioma and radiation treatment for NHL and testicular cancer. 7,19 Travis et al 7 used SEER data through 2001, enhanced by data from other population-based registries in Canada and Europe, to identify 40,576 survivors of testicular cancer who were followed for second cancers.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic radiation for lymphoma

Teta

Lau

Sceurman

et al. 2007

Cancer

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BACKGROUNDIonizing radiation has been used since the 1950s to treat a variety of cancers. Cancer patients who are treated with radiotherapy have shown increased risks for a variety of second malignancies, including mesothelioma, in several recent reports. The only existing study of Hodgkin lymphoma (HL) and subsequent mesothelioma had a short observation period.METHODSThe authors used Surveillance, Epidemiology, and End Results data over a 30‐year period to identify patients with HL and non‐Hodgkin lymphoma (NHL) who also were diagnosed with mesothelioma. Standardized incidence ratios (SIR) and absolute excess risks were calculated by sex and treatment modality for both types of lymphoma.RESULTSTwenty‐six patients were identified who had mesothelioma as second primaries based on 21,881 diagnoses of HL and 101,001 diagnoses of NHL. There was a statistically significant increase in mesothelioma (4 diagnoses; SIR, 6.59; 95% confidence interval [95% CI], 1.79–16.87) among men with HL who received radiation, but no women survivors were identified who had a diagnosis of mesothelioma. For NHL survivors, there was a nonsignificant excess of mesothelioma among men (SIR, 1.91; 95% CI, 0.77–3.93) and women (SIR, 3.75; 95% CI, 0.77–10.95) who had received radiation treatment. There were no increases among patients who were unirradiated.CONCLUSIONSMesothelioma rates for patients who had received radiotherapy were increased for survivors of HL and NHL. No increases were observed among the unirradiated. These findings and the existing body of supporting studies confirmed that radiotherapy is a cause of mesothelioma. Cancer 2007. © 2007 American Cancer Society.

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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

Abstract: Radiotherapy volume size reduction from EF to IF after COPP + ABVD chemotherapy for two cycles produces similar results and less toxicity in patients with early-stage unfavorable HD.

Cited by 415 publications

References 24 publications

Linfoma de Hodgkin na infância e adolescência: 15 anos de experiência com o protocolo DH-II-90

Linfoma de Hodgkin na infância e adolescência: 15 anos de experiência com o protocolo DH-II-90

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

Therapeutic radiation for lymphoma

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