title: Consolidative radiation therapy for stage III Hodgkin lymphoma in patients who achieve complete response after ABVD chemotherapy.
abstract: OBJECTIVE
  To examine the role of consolidation radiation therapy (RT) for patients with stage III Hodgkin lymphoma.
  
  
  METHODS
  We retrospectively reviewed 118 patients with stage III Hodgkin lymphoma who were diagnosed and treated at the University of Texas M.D. Anderson Cancer Center from 1993 through 2006. We evaluated the influence of site and size of initial involvement and use of consolidative RT on survival and patterns of failure after complete response (CR) to ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine).
  
  
  RESULTS
  After chemotherapy, 104 patients (88%) achieved CR; median follow-up time was 68 months (range, 8 to 190). Seventy-one patients (68%) received ≥6 cycles of ABVD, and 40 patients (38.5%) received consolidative RT. Comparing patients who received RT with those who did not, the 5-year, 10-year, and 15-year overall survival (OS) rates were 98%, 80%, and 80% versus 91%, 72%, and 29%, respectively (P=0.08). Disease-free survival (DFS) rates were 94%, 81%, 65% versus 78%, 45%, and 15%, respectively (P=0.04). On multivariate analysis, the presence of initial mediastinal involvement (P=0.001) and bulky head and neck disease (P=0.001) was associated with worse DFS; mediastinal RT was associated with improved DFS (P=0.003) and OS (P=0.029). Use of ≥6 cycles of ABVD was associated with improved OS (P=0.001). The pattern of failure analysis showed that most failures (23 of 28) occurred above the diaphragm.
  
  
  CONCLUSIONS
  Consolidative RT after CR may benefit patients with initial disease above the diaphragm, whereas below-the-diaphragm disease seems to be well managed by chemotherapy alone.
authors.affiliation: Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
authors.forename: Ali
authors.initials: A
authors.lastname: Mazloom
authors.forename: Mirna
authors.initials: M
authors.lastname: Abboud
authors.forename: Mohammad
authors.initials: M
authors.lastname: Salehpour
authors.forename: Valerie
authors.initials: V
authors.lastname: Reed
authors.forename: Tony
authors.initials: T
authors.lastname: Zreik
authors.forename: Ferial
authors.initials: F
authors.lastname: Shihadeh
authors.forename: Christine
authors.initials: C
authors.lastname: Fisher
authors.forename: Christine
authors.initials: C
authors.lastname: Wogan
authors.forename: Bouthaina
authors.initials: B
authors.lastname: Dabaja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D001918:Brachytherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin