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Low-dose consolidation radiation therapy for early stage unfavorable Hodgkin lymphoma.

Publication ,  Journal Article
Torok, JA; Wu, Y; Prosnitz, LR; Kim, GJ; Beaven, AW; Diehl, LF; Kelsey, CR
Published in: Int J Radiat Oncol Biol Phys
May 1, 2015

PURPOSE: The German Hodgkin Study Group (GHSG) trial HD11 established 4 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and 30 Gy of radiation therapy (RT) as a standard for early stage (I, II), unfavorable Hodgkin lymphoma (HL). Additional cycles of ABVD may allow for a reduction in RT dose and improved toxicity profile. METHODS AND MATERIALS: Patients treated with combined modality therapy at the Duke Cancer Institute for early stage, unfavorable HL by GHSG criteria from 1994 to 2012 were included. Patients who did not undergo post-chemotherapy functional imaging (positron emission tomography or gallium imaging) or who failed to achieve a complete response were excluded. Clinical outcomes were estimated using the Kaplan-Meier method. Late effects were also evaluated. RESULTS: A total of 90 patients met inclusion criteria for analysis. Median follow-up was 5 years. Chemotherapy consisted primarily of ABVD (88%) with a median number of 6 cycles. The median dose of consolidation RT was 23.4 Gy. Four patients had relapses, 2 of which were in-field. Ten-year progression-free survival (PFS) and overall survival (OS) were 93% (95% confidence interval [CI]: 0.82-0.97) and 98% (95% CI: 0.92-0.99), respectively. For the subset of patients (n=46) who received 5 to 6 cycles of chemotherapy and ≤ 24 Gy, the 10-year PFS and OS values were 88% (95% CI: 70%-96%) and 98% (95% CI: 85% - 99%), respectively. The most common late effect was hypothyroidism (20%) with no cardiac complications. Seven secondary malignancies were diagnosed, with only 1 arising within the RT field. CONCLUSIONS: Lower doses of RT may be sufficient when combined with more than 4 cycles of ABVD for early stage, unfavorable HL and may result in a more favorable toxicity profile than 4 cycles of ABVD and 30 Gy of RT.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2015

Volume

92

Issue

1

Start / End Page

54 / 59

Location

United States

Related Subject Headings

  • Young Adult
  • Vinblastine
  • Retrospective Studies
  • Radiotherapy Dosage
  • Positron-Emission Tomography
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasm Staging
  • Middle Aged
  • Male
 

Citation

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MLA
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Torok, J. A., Wu, Y., Prosnitz, L. R., Kim, G. J., Beaven, A. W., Diehl, L. F., & Kelsey, C. R. (2015). Low-dose consolidation radiation therapy for early stage unfavorable Hodgkin lymphoma. Int J Radiat Oncol Biol Phys, 92(1), 54–59. https://doi.org/10.1016/j.ijrobp.2015.02.003
Torok, Jordan A., Yuan Wu, Leonard R. Prosnitz, Grace J. Kim, Anne W. Beaven, Louis F. Diehl, and Chris R. Kelsey. “Low-dose consolidation radiation therapy for early stage unfavorable Hodgkin lymphoma.Int J Radiat Oncol Biol Phys 92, no. 1 (May 1, 2015): 54–59. https://doi.org/10.1016/j.ijrobp.2015.02.003.
Torok JA, Wu Y, Prosnitz LR, Kim GJ, Beaven AW, Diehl LF, et al. Low-dose consolidation radiation therapy for early stage unfavorable Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):54–9.
Torok, Jordan A., et al. “Low-dose consolidation radiation therapy for early stage unfavorable Hodgkin lymphoma.Int J Radiat Oncol Biol Phys, vol. 92, no. 1, May 2015, pp. 54–59. Pubmed, doi:10.1016/j.ijrobp.2015.02.003.
Torok JA, Wu Y, Prosnitz LR, Kim GJ, Beaven AW, Diehl LF, Kelsey CR. Low-dose consolidation radiation therapy for early stage unfavorable Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):54–59.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2015

Volume

92

Issue

1

Start / End Page

54 / 59

Location

United States

Related Subject Headings

  • Young Adult
  • Vinblastine
  • Retrospective Studies
  • Radiotherapy Dosage
  • Positron-Emission Tomography
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasm Staging
  • Middle Aged
  • Male