title: Radiation therapy for early stage unfavorable Hodgkin lymphoma: is dose reduction feasible?
abstract: One hundred and fifty-one patients aged between 3 and 70 years with early stage unfavorable Hodgkin lymphoma were included. Patients received 4-6 cycles of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) chemotherapy and involved field radiation therapy (IFRT). The most common histology was mixed cellularity (43%). The majority had stage IIAX disease. IFRT doses were 25.2 Gy/14 fractions and 34.2 Gy/19 fractions for adults with a complete response (CR) and partial response (PR), respectively, while the doses were 19.8 Gy/11 fractions and 30.6 Gy/17 fractions, respectively, for children. After 60 months (median), the 10-year progression-free survival (PFS) and overall survival (OS) were 88.4% and 93.2%, respectively. On univariate analysis, prognostic factors with significant impact on PFS were age ≥ 18 years, nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) histology, extranodal disease and response to treatment. Extranodal disease had a significant impact on OS. On multivariate analysis, NLPHL histology (p = 0.001) and response at 3 months (p = 0.000) had a significant impact on PFS. There were no in-field relapses in patients with bulky disease receiving RT doses > 25.2 Gy. Chemotherapy related acute pulmonary toxicity was documented in 21.4% and 4.8% of patients after six and four cycles of ABVD chemotherapy (p = 0.041). Four cycles of ABVD and reduced dose IFRT resulted in optimal outcomes.
authors.affiliation: Department of Radiation Oncology.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Laskar
authors.forename: Deepak P
authors.initials: DP
authors.lastname: Kumar
authors.forename: Nehal
authors.initials: N
authors.lastname: Khanna
authors.forename: Hari
authors.initials: H
authors.lastname: Menon
authors.forename: Manju
authors.initials: M
authors.lastname: Sengar
authors.forename: Brijesh
authors.initials: B
authors.lastname: Arora
authors.forename: Sumeet
authors.initials: S
authors.lastname: Gujral
authors.forename: Tanuja
authors.initials: T
authors.lastname: Shet
authors.forename: Epari
authors.initials: E
authors.lastname: Sridhar
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Rangarajan
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Muckaden
authors.forename: Reena
authors.initials: R
authors.lastname: Nair
authors.forename: Shripad
authors.initials: S
authors.lastname: Banavali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011829:Radiation Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hodgkin lymphoma; prognostication; radiation