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Modern Radiation Plus Chemo Effective and Safe for Early-Stage Hodgkin Lymphoma

Hodgkin lymphoma cells.

According to the results of a new study, combined modality therapy consisting of ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) followed by contemporary radiation therapy (RT) was effective and safe in patients with early-stage favorable Hodgkin lymphoma, with low radiation doses delivered to at-risk organs.

"While maximal efficacy is demonstrated with combined modality therapy, RT is often omitted in fear of late adverse effects," write the investigators, led by first author Chelsea C. Pinnix, MD, PhD, Associate Professor of Radiation Oncology at the University of Texas MD Anderson Cancer Center. "However, the application of modern RT could limit these toxic effects."

Dr. Pinnix and colleagues evaluated the medical records of 42 patients with early-stage Hodgkin lymphoma classified as favorable by the German Hodgkin Study Group (GHSG) criteria. Patients were treated with two cycles of ABVD, followed by 20 Gy involved-site RT upon achieving a complete response to ABVD therapy. Organs at risk, including the heart, lungs, bilateral breasts, thyroid, and salivary glands, were contoured. The study's primary end points were progression-free survival and overall survival. Planning goals for organs at risk included a mean heart dose of 5 Gy or less, a mean lung dose of 13.5 Gy or less, and a mean breast dose of 4 Gy or less.

At a median follow-up of 44.6 months, ABVD followed by contemporary RT produced a three-year progression-free survival rate of 91.2% and a three-year overall survival rate of 97.0%. Median progression-free and overall survival were not reached. Treatment was well tolerated, with only one grade 3 adverse event and no grade 4 or 5 events. The combination of ABVD and RT effectively avoided excess doses to organs at risk, with a mean heart dose of 0.8 Gy and a mean dose of 0.1 Gy for each breast.

"The findings of this study indicate that two cycles of ABVD followed by 20 Gy RT is an effective strategy for the management of early-stage favorable Hodgkin lymphoma," conclude Dr. Pinnix and colleagues in their publication in JAMA Network Open. "The favorable dosimetric profiles, with mean doses of less than five Gy to surrounding normal structures, suggest that long-term toxic effects may be lower than what has been reported in historic series. We advise that treatment strategies for patients with early-stage Hodgkin lymphoma, including the incorporation of RT, be considered on a case-by-case basis."

For More Information

Pinnix CC, Gunther JR, Fang P, et al (2020). Assessment of radiation doses delivered to organs at risk among patients with early-stage favorable Hodgkin lymphoma treated with contemporary radiation therapy. JAMA Netw Open, 3(9)e2013935. DOI:10.1001/jamanetworkopen.2020.13935

Image credit: Calicut Medical College, Department of Pathology. Licensed under CC BY-SA 4.0

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