Involved-Field (If) Versus Extended-Field (Ef) Radiation Therapy (Rt) For Patients In Early Unfavorable Stages Of Hodgkin Lymphoma: 10-Year Update Of The Hd8 Trial Of The German Hodgkin Study Group (Ghsg)

Purpose/Objective(s)Combined modality treatment consisting of chemotherapy followed by RT has shown better results in respect to overall survival (OS), progression free survival (PFS) and freedom from treatment failure (FFTF) compared to RT alone for patients in early unfavorable stages of HL. The HD8 trial was designed to test whether IF-RT is as effective as EF-RT. The main aim was to reduce treatment related toxicity. The present analysis shows the 10-year follow-up data.Materials/MethodsThe HD8 study was a two arm randomized trial. Patients with de novo HL in clinical stages I and II having one or more risk factors (1) large mediastinal mass, (2) extranodal disease, (3) massive spleen involvement, (4) elevated ESR or (5) ≥3 involved lymph node areas), IIB having risk factor (4) or (5) and patients in clinical stages IIIA without risk factors received two cycles of COPP/ABVD followed by RT. RT consisted of either 30 Gy EF-RT (arm A) + 10 Gy to initial bulky disease or 30 Gy IF-RT (arm B) + 10 Gy to initial bulky disease.ResultsFrom 1993 to 1998, a total of 1,204 patients were randomized. Five hundred thirty-two patients in each treatment arm were eligible. The 10-year follow-up analysis revealed no arm differences with respect to FFTF (79.8% vs. 79.7%), PFS (79.8% vs. 80%) and OS (86.4% vs. 87.3%), respectively. Non-inferiority of IF-RT was demonstrated for the primary endpoint FFTF (95% CI for HR = 0.72-1.25). Older patients showed a poorer outcome when treated with EF-RT. Fifteen percent of patients in arm A and 12.2% patients in arm B died due to secondary malignancies (5.3% vs. 3.4%) or HL (3.2% vs. 3.4%). Patients treated with EF-RT developed more often secondary malignancies (n = 58 vs. n = 45), especially AMLs (n = 11 vs. n = 4).ConclusionsReduction of RT-size and RT-volume from EF to IF does not result in poorer long-term outcome and is associated with less long-term toxicity for patients in early unfavorable stages of HL. Purpose/Objective(s)Combined modality treatment consisting of chemotherapy followed by RT has shown better results in respect to overall survival (OS), progression free survival (PFS) and freedom from treatment failure (FFTF) compared to RT alone for patients in early unfavorable stages of HL. The HD8 trial was designed to test whether IF-RT is as effective as EF-RT. The main aim was to reduce treatment related toxicity. The present analysis shows the 10-year follow-up data. Combined modality treatment consisting of chemotherapy followed by RT has shown better results in respect to overall survival (OS), progression free survival (PFS) and freedom from treatment failure (FFTF) compared to RT alone for patients in early unfavorable stages of HL. The HD8 trial was designed to test whether IF-RT is as effective as EF-RT. The main aim was to reduce treatment related toxicity. The present analysis shows the 10-year follow-up data. Materials/MethodsThe HD8 study was a two arm randomized trial. Patients with de novo HL in clinical stages I and II having one or more risk factors (1) large mediastinal mass, (2) extranodal disease, (3) massive spleen involvement, (4) elevated ESR or (5) ≥3 involved lymph node areas), IIB having risk factor (4) or (5) and patients in clinical stages IIIA without risk factors received two cycles of COPP/ABVD followed by RT. RT consisted of either 30 Gy EF-RT (arm A) + 10 Gy to initial bulky disease or 30 Gy IF-RT (arm B) + 10 Gy to initial bulky disease. The HD8 study was a two arm randomized trial. Patients with de novo HL in clinical stages I and II having one or more risk factors (1) large mediastinal mass, (2) extranodal disease, (3) massive spleen involvement, (4) elevated ESR or (5) ≥3 involved lymph node areas), IIB having risk factor (4) or (5) and patients in clinical stages IIIA without risk factors received two cycles of COPP/ABVD followed by RT. RT consisted of either 30 Gy EF-RT (arm A) + 10 Gy to initial bulky disease or 30 Gy IF-RT (arm B) + 10 Gy to initial bulky disease. ResultsFrom 1993 to 1998, a total of 1,204 patients were randomized. Five hundred thirty-two patients in each treatment arm were eligible. The 10-year follow-up analysis revealed no arm differences with respect to FFTF (79.8% vs. 79.7%), PFS (79.8% vs. 80%) and OS (86.4% vs. 87.3%), respectively. Non-inferiority of IF-RT was demonstrated for the primary endpoint FFTF (95% CI for HR = 0.72-1.25). Older patients showed a poorer outcome when treated with EF-RT. Fifteen percent of patients in arm A and 12.2% patients in arm B died due to secondary malignancies (5.3% vs. 3.4%) or HL (3.2% vs. 3.4%). Patients treated with EF-RT developed more often secondary malignancies (n = 58 vs. n = 45), especially AMLs (n = 11 vs. n = 4). From 1993 to 1998, a total of 1,204 patients were randomized. Five hundred thirty-two patients in each treatment arm were eligible. The 10-year follow-up analysis revealed no arm differences with respect to FFTF (79.8% vs. 79.7%), PFS (79.8% vs. 80%) and OS (86.4% vs. 87.3%), respectively. Non-inferiority of IF-RT was demonstrated for the primary endpoint FFTF (95% CI for HR = 0.72-1.25). Older patients showed a poorer outcome when treated with EF-RT. Fifteen percent of patients in arm A and 12.2% patients in arm B died due to secondary malignancies (5.3% vs. 3.4%) or HL (3.2% vs. 3.4%). Patients treated with EF-RT developed more often secondary malignancies (n = 58 vs. n = 45), especially AMLs (n = 11 vs. n = 4). ConclusionsReduction of RT-size and RT-volume from EF to IF does not result in poorer long-term outcome and is associated with less long-term toxicity for patients in early unfavorable stages of HL. Reduction of RT-size and RT-volume from EF to IF does not result in poorer long-term outcome and is associated with less long-term toxicity for patients in early unfavorable stages of HL.