James E Bates1, Sughosh Dhakal2, Ali Mazloom3, Carla Casulo4, Louis S Constine5. 1. Department of Radiation Oncology, University of Florida, Gainesville, USA. 2. Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA. 3. Tacoma Valley Radiation Oncology Center, USA. 4. Department of Medicine, Division of Medical Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA. 5. Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA. Electronic address: louis_constine@urmc.rochester.edu.
Abstract
BACKGROUND: While stage III and IV classical Hodgkin lymphoma (HL) patients are often combined and defined as "advanced stage," there are significant differences in disease distribution and burden between the two stages. This may obscure advantages of radiotherapy (RT) in a combined modality therapy strategy in stage III disease due to the relative lack of benefit in stage IV patients. METHODS: We queried the Surveillance, Epidemiology, and End Results (SEER) database, restricting our search to patients with stage III classical HL diagnosed from 2004 to 2012, to examine the difference in overall and cause-specific survival (OS and CSS) between patients who did or did not receive RT. RESULTS: Patients treated with RT had improved OS and CSS relative to those treated without RT (5-year OS 91.6% with RT compared to 71.4% without RT, HR=0.34, p<0.001) and CSS (5-year OS 95.4% with RT compared to 84.7% without RT, HR=0.32, p<0.001). A benefit in OS and/or CSS was seen in all patient subgroups except for older adults (>64years). CONCLUSION: These data support at least a cautionary approach to omitting RT from treatment strategies for patients with advanced stage HL.
BACKGROUND: While stage III and IV classical Hodgkin lymphoma (HL) patients are often combined and defined as "advanced stage," there are significant differences in disease distribution and burden between the two stages. This may obscure advantages of radiotherapy (RT) in a combined modality therapy strategy in stage III disease due to the relative lack of benefit in stage IV patients. METHODS: We queried the Surveillance, Epidemiology, and End Results (SEER) database, restricting our search to patients with stage III classical HL diagnosed from 2004 to 2012, to examine the difference in overall and cause-specific survival (OS and CSS) between patients who did or did not receive RT. RESULTS:Patients treated with RT had improved OS and CSS relative to those treated without RT (5-year OS 91.6% with RT compared to 71.4% without RT, HR=0.34, p<0.001) and CSS (5-year OS 95.4% with RT compared to 84.7% without RT, HR=0.32, p<0.001). A benefit in OS and/or CSS was seen in all patient subgroups except for older adults (>64years). CONCLUSION: These data support at least a cautionary approach to omitting RT from treatment strategies for patients with advanced stage HL.