Consolidative Radiation Therapy (RT) for Advanced Stage Hodgkin’s Lymphoma (HL) May Improve Progression Free Survival Than ABVD Alone for Adult Patients.

Abstract

The use of RT was associated with improved 5- and 10- years overall survival, especially for early stage Hodgkin’s Lymphoma (Bates et al 2017; Master et al 2017; Odei et al 2017). However, there is no consensus for the use of RT in advanced stage Hodgkin’s disease. We sought to compare outcomes for advanced stage HL patients undergoing RT at our institution, compared with those receiving only ABVD. After receiving Institutional Review Board approval, we captured patient, tumor and treatment characteristics, along with known adverse risk factors as well as toxicity for all advanced stage HL patients treated from 2000 – 2016. Overall survival (OS), and progression-free survival (PFS) were estimated and compared between patients who received consolidative RT versus those who only received chemotherapy. Radiation therapy had to be delivered with 90 days of completing chemotherapy. Pediatric patients were omitted from this analysis. A total of 340 patients with stage III/IV Hodgkin’s Lymphoma were analyzed. Only 47 patients received RT, with only 24 receiving consolidative RT within 90 days of chemotherapy completion. The cohort which received consolidative radiation therapy (n=24) had a 1-year (yr) PFS of 90.0% [65.6, 97.4%], a 2-yr PFS of 75% [50.0%, 88.7%], and a 5-yr PFS of 64.6% [39.7%, 81.3%]. 16 of the patients in this cohort received ABVD chemotherapy, while 4 patients received Stanford V, 3 received BEOCOPP, and 1 received MOPP. As long as radiation therapy was administered at some point after the initial diagnosis (n=47), the 5-yr OS was 100%. The cohort which received ABVD chemotherapy and consolidative RT (n=13) had a 1-yr PFS of 83.9% [49.4%, 95.7%], 2-yr PFS of 58.7% [27.4%, 80.4%], and a 5-Yr PFS of 50.3% [21.2%, 73.9%]. This was further compared with a group of 161 patients who received ABVD alone. The ABVD alone group had a 1-Yr PFS of 59.6% [51.4%, 66.9%], a 2-Yr PFS of 42.5% [34.4%, 50.3%], and a 5-Yr PFS of 28.0% [20.5%, 35.9%]. The ABVD alone cohort had a 1-yr and 2-yr OS of 100% and a 5-yr OS of 96.1% [88.5%, 98.7%]. Borderline Significance was seen when comparing the PFS of the ABVD alone cohort with the ABVD and consolidative RT cohort (p=0.085). Consolidative radiation therapy may improve 1-, 2-, and 5-years progression free survival than ABVD chemotherapy alone in advanced-stage Hodgkin’s Lymphoma. Future trials should evaluate the role of consolidative RT in advanced stage HL.