title: A population-based cohort study on early-stage Hodgkin lymphoma treated with radiotherapy alone: with special reference to older patients.
abstract: BACKGROUND
  Combined modality treatment has reduced the risk of relapse among younger early-stage Hodgkin lymphoma (HL) patients. Older HL patients may not tolerate chemotherapy and their prognosis is less favorable. We conducted a population-based study to evaluate long-term follow-up outcome in older early-stage HL patients initially treated with radiotherapy (RT) alone.
  
  
  METHODS
  We included 308 consecutive patients (22% were >or=60 years) diagnosed 1972-1999 (median follow-up 20 years; range 1-28). Using Cox regression models we defined risk of relapse and survival in relation to clinical factors.
  
  
  RESULTS
  272/308 (88%) patients obtained complete remission following first-line RT alone. Among these, 42% relapsed within a median of 21 months. The relapse rate was independent of gender and age at diagnosis (median age 32 years, range 14-85); however, lymphocyte-predominant HL was associated with borderline (P=0.049) 56% decreased risk of relapse. Among patients<60 years and >or=60 years, we observed 29 (median latency 10 years, range 2-25) and 11 (median latency 3 years, range 1-10) second tumors, respectively.
  
  
  CONCLUSIONS
  Older age (>or=60 years) was not associated with an increased risk of relapse following RT alone. Given the risks of iatrogenic morbidity/mortality of chemotherapy in older patients, RT alone could be an alternative first-line therapy in early-stage older HL patients.
authors.affiliation: Hematology Center, Department of Medicine, Karolinska University Hospital and Institutet, Solna, Stockholm, Sweden. landgreo@mail.nih.gov
authors.forename: O
authors.initials: O
authors.lastname: Landgren
authors.forename: U
authors.initials: U
authors.lastname: Axdorph
authors.forename: T R
authors.initials: TR
authors.lastname: Fears
authors.forename: A
authors.initials: A
authors.lastname: Porwit-MacDonald
authors.forename: C
authors.initials: C
authors.lastname: Wedelin
authors.forename: M
authors.initials: M
authors.lastname: Björkholm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011153:Population; D011379:Prognosis; D016896:Treatment Outcome