title: Outcomes After Chemotherapy Followed by Radiation for Stage IIB Hodgkin Lymphoma With Bulky Disease.
abstract: BACKGROUND
  Treatment of stage IIB bulky Hodgkin lymphoma (HL) is controversial, with treatment varying by institution. We evaluated patients with IIB bulky disease treated with combined-modality therapy at our institution by describing their long-term outcomes.
  
  
  METHODS
  We identified 149 consecutive patients with stage IIB bulky HL treated between 1971 and 2012. Clinical, pathologic, and treatment characteristics were extracted from medical records. Actuarial overall survival (OS) and relapse-free survival (RFS) were calculated by the Kaplan-Meier method. Independent factors associated with these outcomes were identified by a multivariate Cox regression model. Outcomes were further compared against comparison groups of both advanced-stage and stage IIB patients treated between 1971 and 2009.
  
  
  RESULTS
  The 8-year OS rate for patients with stage IIB bulky disease who received combined-modality ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and radiation was 88.8%; the 8-year RFS rate was 76.8%. On multivariate analysis, age < 40 years (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.14-0.57; P = .001), receipt of ABVD (vs. MOPP [mechlorethamine, vincristine, procarbazine, prednisone]; HR, 0.32; 95% CI, 0.10-0.88; P = .028), and radiation dose ≥ 30.1 Gy (HR, 0.25; 95% CI, 0.11-0.65; P = .006) were associated with improved OS. Cardiac events (n = 11) and secondary malignancies (n = 11) only occurred in patients treated before 1995. A subgroup analysis demonstrated significantly improved survival in IIB bulky versus advanced-stage patients (8-year OS, 73.4% vs. 57.4%; P = .008). Improved outcomes in patients with in IIB bulky disease were especially evident in the modern era (> 1995; P = .004).
  
  
  CONCLUSIONS
  Patients with stage IIB bulky HL had excellent outcomes after combined-modality therapy. Treatment strategies have changed substantially over time, with concomitant improvements in disease outcomes and long-term toxicities.
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Jay P
authors: JP
authors: Reddy
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX.
authors: Mani
authors: M
authors: Akhtari
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Grace L
authors: GL
authors: Smith
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Chelsea
authors: C
authors: Pinnix
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Eleanor M
authors: EM
authors: Osborne
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Jillian R
authors: JR
authors: Gunther
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Pamela K
authors: PK
authors: Allen
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Zeinab Abou
authors: ZA
authors: Yehia
authors: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Michelle
authors: M
authors: Fanale
authors: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: M Alma
authors: MA
authors: Rodriguez
authors: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Nathan
authors: N
authors: Fowler
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Sarah A
authors: SA
authors: Milgrom
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Christine F
authors: CF
authors: Wogan
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: bdabaja@mdanderson.org.
authors: Bouthaina S
authors: BS
authors: Dabaja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D059248:Chemoradiotherapy; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: B symptoms; Bulky; Chemotherapy; Hodgkin lymphoma; Radiation