ACR Appropriateness Criteria® Hodgkin Lymphoma-Unfavorable Clinical Stage I and II.
These guidelines review the historical evolution of treatment for early-stage Hodgkin lymphoma (HL) with current standards that rely on prognostic factors to risk stratify and direct current treatment schemes that includes differentiation of favorable and unfavorable presentations. The major clinical trials for unfavorable early-stage HL are reviewed. Patients in this heterogenous subgroup of classic HL are best managed with sequential chemotherapy and radiotherapy. The role of imaging response assessment as a means to modify therapy is a strategy under investigation. Tailoring the radiation treatment volume and radiation dose prescription along with selective use of modern conformal techniques is expected to help reduce long-term toxicities. Many patients are well served receiving involved-site radiotherapy to 30 Gy after appropriate systemic therapy intensity; but, there are nuances for which some variations in the chemotherapy and radiotherapy specifics are appropriately individualized. Following a discussion of the current evidence-based treatment algorithms, several different example cases are reviewed to help physicians make appropriate treatment decisions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
*Yale University School of Medicine, New Haven, CT †Memorial Sloan Kettering Cancer Center, New York, American Society of Clinical Oncology ¶University of Rochester Medical Center, Rochester, NY ‡Princess Margaret Hospital, Toronto, ON, Canada §Stanford Cancer Center, Stanford, CA, American Society of Clinical Oncology ∥University of Texas MD Anderson Cancer Center, Houston **University of Texas Health Science Center at San Antonio, San Antonio, TX #Emory University, Atlanta, GA, American Society of Clinical Oncology ††University of Florida Proton Therapy Institute, Jacksonville ‡‡University of Florida, Gainesville, FL §§St Jude Children's Research Hospital, Memphis, TN, American Society of Clinical Oncology ∥∥University of Pennsylvania Health System, Philadelphia, PA ¶¶Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN ##The University of Chicago, Chicago, IL, American Society of Hematology ***Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD †††Massachusetts General Hospital, Boston, MA.
Kenneth B
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Roberts
Anas
A
Younes
David C
DC
Hodgson
Ranjana
R
Advani
Bouthaina S
BS
Dabaja
Sughosh
S
Dhakal
Christopher R
CR
Flowers
Chul S
CS
Ha
Bradford S
BS
Hoppe
Nancy P
NP
Mendenhall
Monika L
ML
Metzger
John P
JP
Plastaras
Ronald
R
Shapiro
Sonali M
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Smith
Stephanie A
SA
Terezakis
Karen M
KM
Winkfield
Louis S
LS
Constine
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D017410:Practice Guidelines as Topic; D011879:Radiotherapy Dosage; D012008:Recurrence