Long-term Outcome of Involved Node Radiation Therapy for Early Stage Hodgkin Lymphoma

Abstract

Involved node radiation therapy (INRT) in the combined modality treatment (CMT) of early stage Hodgkin lymphoma (ESHL) has dramatically reduced the irradiated volume thereby reducing the risk of late effects. Here we present the long-term outcome of this treatment in a cohort of ESHL patients. Updated results of CMT including INRT in a cohort of 97 patients with classical ESHL treated from 2005 until 2010 were collected from national registries. Overall survival (OS), progression free survival (PFS), defined as time from date of diagnosis to progression or death of any cause, and time to progression (TTP) used as a measure to evaluate tumor control and defined as time from date of diagnosis to progression or death due to HL, were calculated using the Kaplan-Meier method. Patient characteristics are shown in Table 1. Median follow-up time for patients still alive was 126 months (range: 10–160). Four patients were lost to follow up due to emigration abroad (2) or to North Atlantic territory (2). Seven patients relapsed (crude relapse rate: 7.2%) after a median of 36 months (range: 7-113), three in initially involved and irradiated nodes, four in initially uninvolved and not irradiated nodes. A total of 17 patients died, none from HL. 5- and 10-year Kaplan-Meier data were: OS: 90.6% (95% CI: 84.7-96.5) and 83.6% (95% CI: 76.0-91.2); PFS: 86.4% (95% CI: 79.3-93.5) and 76.7% (95% CI: 67.9-85.5); TTP: 94.6% (95% CI: 90.1-99.1) and 91.4% (95% CI: 85.1-97.7). 23 serious late events occurred, of which 12 were malignancies, three lymphomas (mucosa-associated lymphoid tissue, small lymphocytic lymphoma, angioimmunoblastic T-cell lymphoma) and nine solid tumors (two breast, one each of colon, lung, prostate, kidney, endometrial, melanoma) and 11 were cardiac events, four ischemic, five atrial flutter, one Wolff-Parkinson-White syndrome and one valvular. Another 63 minor events possibly related to treatment were reported, hypothyroidism (13.4%) and reduced lung capacity (12.4%) were the most frequent.Abstract 254; Table 1Patientsn(%)No. of patients97Gender Men50(51.6) Women47(48.4)Age, y, median range36(15-87)Chemotherapy ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)90(92.8) Other7(7.2)Radiation therapy With boost (to 36 Gy)71(73.2) Without boost (30.6 Gy)26(26.8) Open table in a new tab CMT including INRT provides excellent local lymphoma control in patients with ESHL and maintains the high survival rates with more than 10 years of follow-up. Further analyses of the observed late events and their relation to chemo- or radiation therapy are ongoing.