Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Abstract

BACKGROUNDThe curative potential of radiotherapy (RT) alone as initial treatment for patients with Stage I–II lymphocyte‐predominant Hodgkin lymphoma (LPHL) has not been defined well.METHODSTwo hundred two patients who were treated between 1969 and 1995 were evaluated in a retrospective, multicenter study.RESULTSPatient characteristics were as follows: The median age was 31 years, 75% of patients were male, 80% of patients had Ann Arbor Stage I disease, 1% of patients had bulky disease, 3% of patients had B symptoms, 1% of patients had extranodal involvement, and 80% of patients had supradiaphragmatic disease. The RT fields were a full mantle field in 52% of patients, less than a full mantle field in 24% of patients, an inverted‐Y field in 17% of patients, less than an inverted‐Y field in 3% of patients, and total lymph node irradiation in 3% of patients. The median dose was 36 Gray. The median follow‐up was 15 years. The overall survival (OS) rate at 15 years was 83%, and freedom from progression (FFP) was observed in 82% of patients, including 84% of patients with Stage I disease and 73% of patients with Stage II disease. No recurrent LPHL and only 1 patient with non‐Hodgkin lymphoma (NHL) were reported after 15 years. Adverse prognostic factors that were identified on multifactor analysis were as follows: for OS, age 45 years or older (P < 0.0005), the presence of B symptoms (P = 0.002), increasing number of sites (P = 0.015); for FFP, increasing number of sites (P = 0.002). No significant difference was found in FFP in a comparison of patients who received elective mediastinal RT with patients who did not receive mediastinal RT (P = 0.11). Causes of death at 15 years were LPHL in 3% of patients, NHL in 2% of patients, in‐field malignancy in 2% of patients, in‐field cardiac/respiratory in 4% of patients, and other in 6% of patients.CONCLUSIONSThe current data suggested that RT potentially may be curative for patients with Stage I–II LPHL and raise the possibility that limited‐field RT may be used without loss of treatment efficacy. Involved‐field RT warrants further investigation for patients with early‐stage LPHL. Cancer 2005. © 2005 American Cancer Society.

Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study

“…6 The risk of progression was reduced with radiotherapy compared to watchful waiting. However, with a 4-year PFS estimate of 79.6% for patients treated with radiotherapy alone, the benefit of radiotherapy is inferior to the results of previously published studies, 8,13,14 and relapses occurred in most cases outside the irradiated fields. Due to the low number of patients and events, a comparison between the results of radiotherapy in stage I and stage II was not possible.…”

Hodgkin’s Lymphoma

“…[19][20][21][24][25][26][27] However, excellent results are also obtained with combined modality therapy, as shown by clinical trials of the German Hodgkin Study Group. 19,26 When RT alone is used, involved field or slightly extended field RT should be adequate (Table 3), without resorting to the use of classical extended field techniques such as the Mantle (Fig 2A and B), or inverted Y fields.…”

“…19,26 When RT alone is used, involved field or slightly extended field RT should be adequate (Table 3), without resorting to the use of classical extended field techniques such as the Mantle (Fig 2A and B), or inverted Y fields. 20,27 Despite very high response rate, relapses are common, characteristically occurring late in follow up, compared with patients with classical HL. However, it appears that patients relapsing with NLPHL has a better outcome compared with other classical HL patients and that death from NLPHL is uncommon.…”

Nodular lymphocyte-predominant Hodgkin’s lymphoma

“…Causes of death at 15 years were LPHL in 3% of patients, NHL in 2%, in-field malignancy in 2%, in-field cardiac or respiratory causes in 4%, and other in 6%. The authors demonstrated that radiotherapy may be curative for patients with Stage I or II LPHL and suggested that limited-field radiotherapy might be used without loss of treatment efficacy in this patient group [19].…”

“…Establishing a standard treatment for LPHL patients in early stages is difficult, however, because of the low incidence of LPHL and the very few events observed in early stages. As a result, treatment of early LPHL is rather heterogeneous, including extendedfield radiotherapy (EF-RT), involved-field radiotherapy (IF-RT), combined-modality (CM) treatment, and, more recently, monoclonal antibodies [6•, 7,8,19,20].…”