title: Chemotherapy alone versus chemotherapy plus radiotherapy for early stage Hodgkin lymphoma.
abstract: BACKGROUND
  Combined modality treatment (CMT) consisting of chemotherapy followed by localised radiotherapy is standard treatment for patients with early stage Hodgkin lymphoma (HL). However, due to long term adverse effects such as secondary malignancies, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication.
  
  
  OBJECTIVE
  We performed a systematic review with meta-analysis of randomised controlled trials (RCTs) comparing chemotherapy alone with CMT in patients with early stage Hodgkin lymphoma with respect to response rate, progression-free survival (alternatively tumour control) and overall survival (OS).
  
  
  METHODS
  We searched MEDLINE, EMBASE and CENTRAL as well as conference proceedings from January 1980 to November 2010 for randomised controlled trials comparing chemotherapy alone to the same chemotherapy regimen plus radiotherapy.
  
  
  METHODS
  Randomised controlled trials comparing chemotherapy alone with CMT in patients with early stage HL. Trials in which the chemotherapy differed between treatment arms were excluded. Trials with more than 20% of patients in advanced stage were also excluded.
  
  
  METHODS
  Effect measures used were hazard ratios (HR) for tumour control and OS as well as relative risks for response rates. Two review authors independently extracted data and assessed quality of trials. We contacted study authors to obtain missing information. Since none of the trials reported progression-free survival according to our definitions, all similar outcomes were evaluated as tumour control.
  
  
  RESULTS
  Five RCTs involving 1245 patients were included. The HR was 0.41 (95% confidence interval (CI) 0.25 to 0.66) for tumour control and 0.40 (95% CI 0.27 to 0.61) for OS for patients receiving CMT compared to chemotherapy alone. Complete response rates were similar between treatment groups. In sensitivity analyses another six trials were included that did not fulfil the inclusion criteria of our protocol but were considered relevant to the topic. These trials underlined the results of the main analysis.
  
  
  CONCLUSIONS
  Adding radiotherapy to chemotherapy improves tumour control and overall survival in patients with early stage Hodgkin lymphoma.
authors.affiliation: Oberstr 116, Cologne, Germany, 51149.
authors.forename: Christine
authors.initials: C
authors.lastname: Herbst
authors.forename: Fareed Ahmed
authors.initials: FA
authors.lastname: Rehan
authors.forename: Nicole
authors.initials: N
authors.lastname: Skoetz
authors.forename: Julia
authors.initials: J
authors.lastname: Bohlius
authors.forename: Corinne
authors.initials: C
authors.lastname: Brillant
authors.forename: Holger
authors.initials: H
authors.lastname: Schulz
authors.forename: Ina
authors.initials: I
authors.lastname: Monsef
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis