title: Involved field radiation therapy following high dose chemotherapy and autologous stem cell transplant benefits local control and survival in refractory or recurrent Hodgkin lymphoma.
abstract: OBJECTIVE
  Patients with recurrent or primary refractory Hodgkin lymphoma (HL) treated with high dose chemotherapy (HDT) and autologous stem cell transplant (ASCT) commonly relapse post-ASCT in previous disease sites. We sought to evaluate involved field radiation therapy (IFRT) following ASCT and patterns of recurrence, overall survival (OS), and disease specific survival (DSS).
  
  
  METHODS
  Between May 1993 and October 2003, 62 (n=66) evaluable patients with refractory/relapsed HL underwent HDT followed by ASCT. Thirty-two (52%) patients received IFRT following transplant. Survival was calculated from the day of hematopoietic stem cell infusion.
  
  
  RESULTS
  Median follow-up was 2.3 years (range 0.03-11.56). Estimated 3-year OS (p=0.05) and DSS (p=0.08) were 69.6% and 82.1% with IFRT and 40% and 57.6% without IFRT on univariate analysis. B-symptoms were adverse on univariate (p=0.007) and multivariate (p=0.01) analysis. HL patients who received IFRT following ASCT had improved local control in areas of previously recurrent disease (p=0.03).
  
  
  CONCLUSIONS
  OS and DSS showed marginal benefit at 3 years. Given the retrospective nature of our study and attendant selection bias that can be both positive and negative, a future prospective study is warranted to better understand the value of IFRT in the transplant setting.
authors.affiliation: Department of Radiation Oncology, East Carolina University, Greenville, North Carolina, USA.
authors.forename: Tithi
authors.initials: T
authors.lastname: Biswas
authors.forename: Eva
authors.initials: E
authors.lastname: Culakova
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kelly
authors.forename: Sughosh
authors.initials: S
authors.lastname: Dhakal
authors.forename: Jane
authors.initials: J
authors.lastname: Liesveld
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Phillips
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D006801:Humans; D008297:Male; D012008:Recurrence; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014182:Transplantation, Autologous