Table 1.
Studies incorporating radiation therapy for the treatment of advanced stage Hodgkin lymphoma
| Trial | Chemotherapy | Radiation | PET era | Outcome |
|---|---|---|---|---|
| UK Lymphoma Group LY094 | ABVD vs ChIVPP/PABIOE vs ChIVIPP/EVA | Recommended for initial bulky disease or residual CT mass | No | PFS and OS superior for RT despite more bulky disease and less CR on retrospective analysis |
| EORTC11 | MOPP-ABV | Pts with CR randomized to RT vs no RT; RT for all pts w/ PR | No | No difference in EFS or OS for RT for pts with CR; rates of EFS and OS for PR → RT similar to pts with CR |
| GHSG HD1212 | escBEACOPP ×8 vs escBEACOPP ×4 —> BEACOPP | Pts w/bulky disease ≥5 cm or residual disease ≥1.5 cm randomized to RT vs no RT | No | On subgroup analysis, RT improved FFTF in pts w/ residual disease but not pts w/ initial bulky disease with CR |
| GHSG HD157 | escBEACOPP ×6-8 vs BEACOPP14 | RT for persistent PET avid mass ≥2.5 cm | Yes | Low relapse rates in PET negative pts who did not receive RT (4-y PFS 92.6%); PFS for PET positive pts who received RT 86.2% |
| RATHL9 | ABVD → ABVD or AVD vs BEACOPP | Pts with negative interim PET not recommended for RT (consolidative RT in only 6.5% of pts) | Yes | 3-y PFS 67.5% and OS 87.8% |
| ECOG E249614 | ABVD vs Stanford V | RT for all pts with bulky disease (75% in Stanford V arm and 41% in ABVD arm) | No | 5-y OS 88% in both arms |
| GITIL/FIL trial HD 060715 | ABVD → escBEACOPP vs BEACOPP ± rituximab | Pts w/ bulky disease but negative final PET randomized to RT or no RT | Yes | No SS difference in 3-y PFS w/RT (97%) vs no RT (93%); also no SS when limited analysis to bulky disease >10 cm: 3-y PFS w/RT (94%) vs no RT (86%) |
| FIL trial HD 0801 (abstract only)16 | ABVD | Pts with bulky disease and CR on PET randomized to RT or no RT | Yes | 10.3% 3-y PFS benefit in RT arm but not SS |
| ECHELON-118 | Bv + AVD vs ABVD | In both chemotherapy arms pts received RT for residual disease (n = 54-55 in each arm) | Yes | 2-y PFS 82% for Bv + AVD and 77% for ABVD |
Abbreviations: ABV = doxorubicin, bleomycin, vinblastine; ABVD = adriamycin, bleomycin, vinblastine, and dacarbazine; BEACOPP = bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone; CR = complete response; ChIVIPP = chlorambucil, vinblastine, procarbazine, and prednisone; CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; EFS = event-free survival; EORCT = European Organization for Research and Treatment; Esc = escalated; EVA = etoposide, vincristine, and doxorubicin; FFTF = freedom from treatment failure; FIL = Fondazione Italiana Linfomi; GHSG = German Hodgkin Study Group; GITIL/FIL = Gruppo Italiano Terapie Innovative nei Linfomi/Fondazione Italiana Linfomi; MOPP = mechlorethamine, vincristine, procarbazine, prednisone; OS = overall survival; PABIOE = doxorubicin, bleomycin, vincristine, etoposide, and prednisolone; PET = positron emission tomography; PFS = progression free survival; PR = partial response; pts = patients; RATHL = Response-adjusted therapy for advanced Hodgkin lymphoma; RT = radiation therapy; SS = statistically significant.