title: Contribution of involved-field radiotherapy to survival in patients with relapsed or refractory Hodgkin lymphoma undergoing autologous stem cell transplantation.
abstract: OBJECTIVE
  To assess the outcomes of overall survival and posttransplantation survival in patients with Hodgkin lymphoma (HL) undergoing autologous stem cell transplantation (ASCT) because of the development of relapse or resistance after chemotherapy (CT) or CT plus radiotherapy (combined modality treatment, CMT).
  
  
  METHODS
  Forty-five patients undergoing ASCT because of the development of relapse or resistance after CT or CMT for HL were enrolled in the study. Radiotherapy was given as involved-field radiotherapy. Patients were treated with CT alone (n=25) or CMT (n=20). These 2 groups were further divided into 2 subgroups: the patients with early-stage (I to II) and advanced-stage (III to IV) HL.
  
  
  RESULTS
  Median patients age was 29 years (range, 16 to 60 y) and the median follow-up was 60 months (range, 12 to 172 mo). In the patients with advanced-stage HL, there was no statistically significant difference in overall survival between irradiated and nonirradiated patients (n=18, irradiated n=4 and nonirradiated n=14). However, in the patients with early-stage disease, there was a significant difference in 5- and 10-year overall survival between the irradiated and nonirradiated groups (81% vs. 48% and 66% vs. 24%, respectively, P=0.045; n=26, irradiated n=16 and nonirradiated n=10). In the univariate analysis, irradiated group and involvement of 1 to 2 nodal regions were found to be significant for overall survival, whereas irradiated group, early stage, and involvement of 1 to 2 nodal regions were found to be significant for posttransplantation survival. However, only irradiated group was found to be significant for posttransplantation survival in multivariate analysis (P<0.05).
  
  
  CONCLUSIONS
  Addition of involved-field radiotherapy to CT in patients undergoing ASCT after relapse or recurrence failed to provide survival benefit in patients with advanced HL, while a survival benefit was observed in patients with early-stage HL. Radiotherapy should be considered as part of CMT in the patients with early-stage HL, which should not be neglected.
authors.affiliation: Departments of *Radiation Oncology, School of Medicine †Hematology and Aphaeresis Unit, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Celalettin
authors.initials: C
authors.lastname: Eroglu
authors.forename: Leylagül
authors.initials: L
authors.lastname: Kaynar
authors.forename: Okan
authors.initials: O
authors.lastname: Orhan
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Keklik
authors.forename: Cem
authors.initials: C
authors.lastname: Sahin
authors.forename: Oğuz G
authors.initials: OG
authors.lastname: Yildiz
authors.forename: Selahattin
authors.initials: S
authors.lastname: Mentes
authors.forename: Fatih
authors.initials: F
authors.lastname: Kurnaz
authors.forename: Dicle
authors.initials: D
authors.lastname: Aslan
authors.forename: Serdar
authors.initials: S
authors.lastname: Sivgin
authors.forename: Serdar
authors.initials: S
authors.lastname: Soyuer
authors.forename: Bülent
authors.initials: B
authors.lastname: Eser
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cetin
authors.forename: Ali
authors.initials: A
authors.lastname: Unal
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D002330:Carmustine / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000627:therapeutic use; D015331:Cohort Studies; D003561:Cytarabine / Q000627:therapeutic use; D003606:Dacarbazine / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006689:Hodgkin Disease / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology / Q000628:therapy*; D008558:Melphalan / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003561:Cytarabine; D001761:Bleomycin; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D003907:Dexamethasone; D004317:Doxorubicin; D016190:Carboplatin; D002945:Cisplatin; D008558:Melphalan; D002330:Carmustine; D007069:Ifosfamide; D008775:Methylprednisolone