Correspondence (reply): In Reply

We thank Oertel and Eich for their response to our article, which—in a somewhat loose connection to the subject—provides an overview of the role of radiotherapy in Hodgkin’s lymphoma (HL), which we support with regard to central issues raised.

As they correctly cited, we explicitly mentioned the context of the GHSG’s HD15 Study, which showed that in advanced stages after standard polychemotherapy (BEACOPPescalated), risk can be successfully stratified by using PET. In PET-negative patients, radiotherapy can be omitted, and the same applies for patients with PET-positive residual findings <2.5 cm (1). In this example, re-staging by using PET shows its potential for an individualized treatment adapted to the prognosis, among others with the aim of avoiding late toxicity, which is of particular relevance in mediastinal irradiation, which can, for example, include the development of secondary malignancies or early coronary heart disease (2).

As far as the UK RAPID Trial is concerned, progression-free three-year survival and overall survival after three cycles of ABVD and with negative findings on PET was 90.8% ad 99.0%, or 94.6% and 97.1% after radiotherapy. The authors concluded that patients with early stage HL and negative PET findings had a very good prognosis after three cycles of ABVD, with or without consolidating radiotherapy (3). The relative significance of a 4% difference in the recurrence rate after three years vis-à-vis the (late) toxicity of additional therapy is the subject of discussion in the context of this study.

The most recently conducted therapy optimization studies of the GHSG (HD16–17) also evaluated the importance of PET for the purpose of treatment stratification in the early and intermediate stages, as well as the question of whether in this disease context, radiotherapy can be omitted for selected patients. We fully agree that until these studies have been analyzed, radiotherapy remains the clinical care standard in these stages.