Vol 70, No 1 (2020)
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Published online: 2020-03-03

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Should adjuvant radiotherapy be used in patients with early stage Hodgkin’s lymphoma? A vote for yes

Ewelina Łata-Woźniak12, Aleksandra Łacko12
Nowotwory. Journal of Oncology 2020;70(1):29-32.


Hodgkin’s lymphoma (HL) belongs to the most radiosensitive and chemosensitive cancers. Combined modality therapy is the preferred treatment for patients with classical favorable early-stage HL. However, late toxicity still remains an issue. A modern approach in HL radiotherapy includes implementation of sophisticated and dedicated delivery techniques together with the lower doses and smaller fields, which allow for reduction of early and late toxicity. In recent years, the question on the need for complementary radiotherapy in the early stages of Hodgkin’s lymphoma has been increasingly raised. The aim of the present review is to discuss the current role of radiotherapy and its potential future developments, with a focus on major clinical trials.

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  1. Eichenauer DA, Aleman BMP, André M, et al. ESMO Guidelines Committee. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018; 29(Suppl 4): iv19–iv29.
  2. Engert A, Plütschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med. 2010; 363(7): 640–652.
  3. Eich HT, Diehl V, Görgen H, 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; 28(27): 4199–4206.
  4. Dörffel W, Rühl U, Lüders H, et al. Treatment of children and adolescents with Hodgkin lymphoma without radiotherapy for patients in complete remission after chemotherapy: final results of the multinational trial GPOH-HD95. J Clin Oncol. 2013; 31(12): 1562–1568.
  5. Wolden SL, Chen Lu, Kelly KM, et al. Long-term results of CCG 5942: a randomized comparison of chemotherapy with and without radiotherapy for children with Hodgkin's lymphoma--a report from the Children's Oncology Group. J Clin Oncol. 2012; 30(26): 3174–3180.
  6. Eichenauer DA, Becker I, Monsef I, et al. Secondary malignant neoplasms, progression-free survival and overall survival in patients treated for Hodgkin lymphoma: a systematic review and meta-analysis of randomized clinical trials. Haematologica. 2017; 102(10): 1748–1757.
  7. Raemaekers JMM, André MPE, Federico M, 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): 1188–1194.
  8. Radford J, Illidge T, Counsell N, et al. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med. 2015; 372(17): 1598–1607.
  9. Fuchs M, Goergen H, Kobe C, et al. PET-Guided Treatment of Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase 3 Trial HD16 By the German Hodgkin Study Group. Blood. 2018; 132(Supplement 1): 925–925.
  10. Svane IM, Pedersen AE, Johansen JS, et al. Vaccination with p53 peptide-pulsed dendritic cells is associated with disease stabilization in patients with p53 expressing advanced breast cancer; monitoring of serum YKL-40 and IL-6 as response biomarkers. Cancer Immunol Immunother. 2007; 56(9): 1485–1499.
  11. Blank O, von Tresckow B, Monsef I, et al. Chemotherapy alone versus chemotherapy plus radiotherapy for adults with early stage Hodgkin lymphoma. Cochrane Database Syst Rev. 2017; 4: CD007110.
  12. Sher DJ, Mauch PM, Van Den Abbeele A, et al. Prognostic significance of mid- and post-ABVD PET imaging in Hodgkin's lymphoma: the importance of involved-field radiotherapy. Ann Oncol. 2009; 20(11): 1848–1853.
  13. Mikhaeel NG, Hutchings M, Fields PA, et al. Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol. 2005; 16(7): 1160–1168.
  14. Barnes JA, LaCasce AS, Zukotynski K, et al. End-of-treatment but not interim PET scan predicts outcome in nonbulky limited-stage Hodgkin's lymphoma. Ann Oncol. 2011; 22(4): 910–915.
  15. Kostakoglu L, Schöder H, Johnson JL, et al. Cancer Leukemia Group B. Interim [(18)F]fluorodeoxyglucose positron emission tomography imaging in stage I-II non-bulky Hodgkin lymphoma: would using combined positron emission tomography and computed tomography criteria better predict response than each test alone? Leuk Lymphoma. 2012; 53(11): 2143–2150.
  16. Zinzani PL, Rigacci L, Stefoni V, et al. Early interim 18F-FDG PET in Hodgkin's lymphoma: evaluation on 304 patients. Eur J Nucl Med Mol Imaging. 2012; 39(1): 4–12.
  17. Terasawa T, Lau J, Bardet S, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography for interim response assessment of advanced-stage Hodgkin's lymphoma and diffuse large B-cell lymphoma: a systematic review. J Clin Oncol. 2009; 27(11): 1906–1914.
  18. Gallamini A, Hutchings M, Avigdor A, et al. Early interim PET scan in Hodgkin lymphoma: where do we stand? Leuk Lymphoma. 2008; 49(4): 659–662.
  19. Akhtari M, Milgrom SA, Pinnix CC, et al. Reclassifying patients with early-stage Hodgkin lymphoma based on functional radiographic markers at presentation. Blood. 2018; 131(1): 84–94.
  20. Bonadonna G, Bonfante V, Viviani S, et al. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. J Clin Oncol. 2004; 22(14): 2835–2841.
  21. Engert A, Schiller P, Josting A, et al. German Hodgkin's Lymphoma Study Group. 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): 3601–3608.
  22. Yahalom J, Illidge T, Specht L, et al. International Lymphoma Radiation Oncology Group, International Lymphoma Radiation Oncology Group, ILROG. Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phys. 2014; 89(4): 854–862.
  23. Johnson DH, Schiller JH, Bunn PA. Recent clinical advances in lung cancer management. J Clin Oncol. 2014; 32(10): 973–982.