title: Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin's lymphoma: an analysis from the German Hodgkin Study Group.
abstract: BACKGROUND
  The optimal treatment of elderly patients with Hodgkin's lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy.
  
  
  METHODS
  In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older.
  
  
  RESULTS
  Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008).
  
  
  CONCLUSIONS
  Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoided.
authors.affiliation: Department I of Internal Medicine, University Hospital Cologne, Germany. beate.klimm@uk-koeln.de
authors.forename: B
authors.initials: B
authors.lastname: Klimm
authors.forename: H T
authors.initials: HT
authors.lastname: Eich
authors.forename: H
authors.initials: H
authors.lastname: Haverkamp
authors.forename: A
authors.initials: A
authors.lastname: Lohri
authors.forename: P
authors.initials: P
authors.lastname: Koch
authors.forename: F
authors.initials: F
authors.lastname: Boissevain
authors.forename: G
authors.initials: G
authors.lastname: Trenn
authors.forename: P
authors.initials: P
authors.lastname: Worst
authors.forename: E
authors.initials: E
authors.lastname: Dühmke
authors.forename: R P
authors.initials: RP
authors.lastname: Müller
authors.forename: K
authors.initials: K
authors.lastname: Müller-Hermelink
authors.forename: B
authors.initials: B
authors.lastname: Pfistner
authors.forename: V
authors.initials: V
authors.lastname: Diehl
authors.forename: A
authors.initials: A
authors.lastname: Engert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003606:Dacarbazine / Q000627:therapeutic use; D018450:Disease Progression; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005858:Germany; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000627:therapeutic use; D011344:Procarbazine / Q000627:therapeutic use; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology*; D015996:Survival Rate; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone