S Sasse1, B Klimm1, H Görgen2, M Fuchs2, A Heyden-Honerkamp2, A Lohri3, O Koch4, M Wilhelm5, G Trenn6, J Finke7, R P Müller8, V Diehl2, H T Eich9, P Borchmann2, A Engert10. 1. First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany. 2. German Hodgkin Study Group, Cologne, Germany. 3. Department of Internal Medicine, Kantonsspital Liestal, Liestal, Switzerland. 4. Third Department of Internal Medicine, Klinikum Osnabrück, Osnabrück. 5. Fifth Department of Internal Medicine, Klinikum Nuernberg, Nuernberg. 6. Department of Internal Medicine, Knappschaftskrankenhaus Bottrop, Bottrop. 7. First Department of Internal Medicine, University Hospital Freiburg, Freiburg. 8. Department of Radiotherapy, University Hospital Cologne, Cologne. 9. Department of Radiotherapy, University Hospital Muenster, Muenster, Germany. 10. First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany. Electronic address: a.engert@uni-koeln.de.
Abstract
BACKGROUND: To evaluate long-term toxicity and efficacy of a combined modality strategy including extended-field radiotherapy (EF-RT) or involved-field radiotherapy (IF-RT), the German Hodgkin Study Group carried out a follow-up analysis in patients with early unfavorable Hodgkin's lymphoma (HL). PATIENTS AND METHODS: One thousand two hundred and four patients were randomized to four cycles of chemotherapy followed by either 30 Gy EF- or 30 Gy IF-RT (HD8 trial); 532 patients in each treatment arm were eligible. RESULTS: At 10 years, no arm differences were revealed with respect to freedom from treatment failure (FFTF) (79.8% versus 79.7%), progression-free survival (79.8% versus 80.0%), and overall survival (86.4% versus 87.3%). Non-inferiority of IF-RT was demonstrated for the primary end point FFTF (95% confidence interval for hazard ratio 0.72-1.25). Elderly patients had a poorer outcome when treated with EF-RT. So far, 15.0% of patients in arm A and 12.2% in arm B died, mostly due to secondary malignancies (5.3% versus 3.4%) or HL (3.2% versus 3.4%). After EF-RT, there were more secondary malignancies overall (58 versus 45), especially acute myeloid leukemias (11 versus 4). CONCLUSION: Radiotherapy intensity reduction to IF-RT does not result in poorer long-term outcome but is associated with less acute toxicity and might be associated with less secondary malignancies.
RCT Entities:
BACKGROUND: To evaluate long-term toxicity and efficacy of a combined modality strategy including extended-field radiotherapy (EF-RT) or involved-field radiotherapy (IF-RT), the German Hodgkin Study Group carried out a follow-up analysis in patients with early unfavorable Hodgkin's lymphoma (HL). PATIENTS AND METHODS: One thousand two hundred and four patients were randomized to four cycles of chemotherapy followed by either 30 Gy EF- or 30 Gy IF-RT (HD8 trial); 532 patients in each treatment arm were eligible. RESULTS: At 10 years, no arm differences were revealed with respect to freedom from treatment failure (FFTF) (79.8% versus 79.7%), progression-free survival (79.8% versus 80.0%), and overall survival (86.4% versus 87.3%). Non-inferiority of IF-RT was demonstrated for the primary end point FFTF (95% confidence interval for hazard ratio 0.72-1.25). Elderly patients had a poorer outcome when treated with EF-RT. So far, 15.0% of patients in arm A and 12.2% in arm B died, mostly due to secondary malignancies (5.3% versus 3.4%) or HL (3.2% versus 3.4%). After EF-RT, there were more secondary malignancies overall (58 versus 45), especially acute myeloid leukemias (11 versus 4). CONCLUSION: Radiotherapy intensity reduction to IF-RT does not result in poorer long-term outcome but is associated with less acute toxicity and might be associated with less secondary malignancies.
Authors: Richard T Hoppe; Ranjana H Advani; Weiyun Z Ai; Richard F Ambinder; Patricia Aoun; Celeste M Bello; Cecil M Benitez; Philip J Bierman; Kristie A Blum; Robert Chen; Bouthaina Dabaja; Andres Forero; Leo I Gordon; Francisco J Hernandez-Ilizaliturri; Ephraim P Hochberg; Jiayi Huang; Patrick B Johnston; Nadia Khan; David G Maloney; Peter M Mauch; Monika Metzger; Joseph O Moore; David Morgan; Craig H Moskowitz; Carolyn Mulroney; Matthew Poppe; Rachel Rabinovitch; Stuart Seropian; Christina Tsien; Jane N Winter; Joachim Yahalom; Jennifer L Burns; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2015-05 Impact factor: 11.908