Skip to main content

Advertisement

Log in

The role of radiation therapy in patients with Hodgkin’s lymphoma

  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

The outcome of patients with Hodgkin’s lymphoma (HL) has improved dramatically because of improvement of both chemotherapy and radiotherapy. The need for radiotherapy in the treatment of patients with HL has changed tremendously. At first, extensive radiation was the only treatment option; then limited irradiation was used in addition to chemotherapy. Whether chemotherapy alone can be sufficient remains to be determined. For patients with early-stage HL with or without risk factors, two to four cycles of relatively mild chemotherapy followed by radiotherapy limited to involved fields (20–30 Gy/10–15 fractions) is widely accepted. For patients with advanced-stage HL, powerful chemotherapy is indicated; when partial remission results, chemotherapy is followed by radiotherapy to residual abnormalities, using only a small margin. In the future, treatment will be tailored to individual patients based on prognostic factors (possibly including biologic markers) and accurate evaluation of response to treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kaplan HS: Hodgkin’s disease: biology, treatment, prognosis. Blood 1981, 57:813–822.

    PubMed  CAS  Google Scholar 

  2. Bonadonna G, Valagussa P, Santoro A: Alternating non-cross-resistant combination chemotherapy or MOPP in stage IV Hodgkin’s disease. A report of 8-year results. Ann Intern Med 1986, 104:739–746.

    PubMed  CAS  Google Scholar 

  3. Aleman BM, van den Belt-Dusebout AW, Klokman WJ, et al.: Long-term cause-specific mortality of patients treated for Hodgkin’s disease. J Clin Oncol 2003, 21:3431–3439.

    Article  PubMed  Google Scholar 

  4. Hancock SL, Hoppe RT: Long-term complications of treatment and causes of mortality after Hodgkin’s disease. Semin Radiat Oncol 1996, 6:225–242.

    Article  PubMed  Google Scholar 

  5. Swerdlow AJ, Barber JA, Hudson GV, et al.: Risk of second malignancy after Hodgkin’s disease in a collaborative British cohort: the relation to age at treatment. J Clin Oncol 2000, 18:498–509.

    PubMed  CAS  Google Scholar 

  6. van Leeuwen FE, Klokman WJ, Veer MB, et al.: Long-term risk of second malignancy in survivors of Hodgkin’s disease treated during adolescence or young adulthood. J Clin Oncol 2000, 18:487–497.

    PubMed  Google Scholar 

  7. Swerdlow AJ, Higgins CD, Smith P, et al.: Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 2007, 99:206–214.

    Article  PubMed  Google Scholar 

  8. Specht L, Gray RG, Clarke MJ, Peto R: Influence of more extensive radiotherapy and adjuvant chemotherapy on long-term outcome of early-stage Hodgkin’s disease: a meta-analysis of 23 randomized trials involving 3,888 patients. International Hodgkin’s Disease Collaborative Group. J Clin Oncol 1998, 16:830–843.

    PubMed  CAS  Google Scholar 

  9. Engert A, Schiller P, Josting A, et al.: Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin’s lymphoma: results of the HD8 trial of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 2003, 21:3601–3608.

    Article  PubMed  Google Scholar 

  10. Diehl V, Brillant C, Engert A, et al.: HD10: Investigating reduction of combined modality treatment intensity in early stage Hodgkin’s lymphoma. Interim analysis of a randomized trial of the German Hodgkin Study Group (GHSG) [abstract]. J Clin Oncol 2005, 23: Abstract 6506.

  11. Noordijk E, Thomas J, Fermé C, et al.: First results of the EORTC-GELA H9 randomized trials: the H9-F trial (comparing 3 radiation dose levels) and H9-U trial (comparing 3 chemotherapy schemes) in patients with favorable or unfavorable early stage Hodgkin’s lymphoma (HL) [abstract]. J Clin Oncol 2005, 23:Abstract 6505.

    Google Scholar 

  12. Meyer RM, Gospodarowicz MK, Connors JM, et al.: Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin’s lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol 2005, 23:4634–4642.

    Article  PubMed  CAS  Google Scholar 

  13. Loeffler M, Brosteanu O, Hasenclever D, et al.: Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin’s disease. International Database on Hodgkin’s Disease Overview Study Group. J Clin Oncol 1998, 16:818–829.

    PubMed  CAS  Google Scholar 

  14. Diehl V, Franklin J, Pfreundschuh M, et al.: Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med 2003, 348:2386–2395.

    Article  PubMed  CAS  Google Scholar 

  15. Aleman BM, Raemaekers JM, Tirelli U, et al.: Involved-field radiotherapy for advanced Hodgkin’s lymphoma. N Engl J Med 2003, 348:2396–2406.

    Article  PubMed  Google Scholar 

  16. Aleman BM, Raemaekers JM, Tomsic R, et al.: Involved-field radiotherapy for patients in partial remission after chemotherapy for advanced Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys 2007, 67:19–30.

    PubMed  Google Scholar 

  17. Tubiana M, Henry-Amar M, Werf-Messing B, et al.: A multivariate analysis of prognostic factors in early stage Hodgkin’s disease. Int J Radiat Oncol Biol Phys 1985, 11:23–30.

    PubMed  CAS  Google Scholar 

  18. Proctor SJ, Taylor P, Mackie MJ, et al.: A numerical prognostic index for clinical use in identification of poor-risk patients with Hodgkin’s disease at diagnosis. The Scotland and Newcastle Lymphoma Group (SNLG) Therapy Working Party. Leuk Lymphoma 1992, 7(suppl):17–20.

    Article  PubMed  Google Scholar 

  19. Hasenclever D, Diehl V: A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998, 339:1506–1514.

    Article  PubMed  CAS  Google Scholar 

  20. van Leeuwen FE, Klokman WJ, Stovall M, et al.: Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin’s disease. J Natl Cancer Inst 2003, 95:971–980.

    Article  PubMed  Google Scholar 

  21. Travis LB, Hill DA, Dores GM, et al.: Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA 2003, 290:465–475.

    Article  PubMed  Google Scholar 

  22. Kremer LC, van Dalen EC, Offringa M, et al.: Anthracycline-induced clinical heart failure in a cohort of 607 children: long-term follow-up study. J Clin Oncol 2001, 19:191–196.

    PubMed  CAS  Google Scholar 

  23. Moser EC, Noordijk EM, van Leeuwen FE, et al.: Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin’s lymphoma. Blood 2005, 107:2912–2919.

    Article  PubMed  CAS  Google Scholar 

  24. Ng AK, Li S, Neuberg D, et al.: Long-term results of a prospective trial of mantle irradiation alone for early-stage Hodgkin’s disease. Ann Oncol 2006, 17:1693–1697.

    Article  PubMed  CAS  Google Scholar 

  25. Noordijk EM, Carde P, Dupouy N, et al.: Combined-modality therapy for clinical stage I or II Hodgkin’s lymphoma: long-term results of the European Organisation for Research and Treatment of Cancer H7 randomized controlled trials. J Clin Oncol 2006, 24:3128–3135.

    Article  PubMed  Google Scholar 

  26. Henry-Amar M, Hayat M, Meerwaldt JH, et al.: Causes of death after therapy for early stage Hodgkin’s disease entered on EORTC protocols. EORTC Lymphoma Cooperative Group. Int J Radiat Oncol Biol Phys 1990, 19:1155–1157.

    PubMed  CAS  Google Scholar 

  27. Klimm B, Eich HT, Haverkamp H, et al.: Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin’s lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol 2007, 18:357–363.

    Article  PubMed  CAS  Google Scholar 

  28. Girinsky T, van der Maazen R, Specht L, et al.: Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol 2006, 79:270–277.

    Article  PubMed  Google Scholar 

  29. Shahidi M, Kamangari N, Ashley S, et al.: Site of relapse after chemotherapy alone for stage I and II Hodgkin’s disease. Radiother Oncol 2006, 78:1–5.

    Article  PubMed  Google Scholar 

  30. Fermé C, Mounier N, Divine M, et al.: Intensive salvage therapy with high-dose chemotherapy for patients with advanced Hodgkin’s disease in relapse or failure after initial chemotherapy: results of the Groupe d’Etudes des Lymphomes de l’Adulte H89 Trial. J Clin Oncol 2002, 20:467–475.

    Article  PubMed  Google Scholar 

  31. Sureda A, Arranz R, Iriondo A, et al.: Autologous stem-cell transplantation for Hodgkin’s disease: results and prognostic factors in 494 patients from the Grupo Espanol de Linfomas/Transplante Autologo de Medula Osea Spanish Cooperative Group. J Clin Oncol 2001, 19:1395–1404.

    PubMed  CAS  Google Scholar 

  32. Wendland MM, Asch JD, Pulsipher MA, et al.: The impact of involved field radiation therapy for patients receiving high-dose chemotherapy followed by hematopoietic progenitor cell transplant for the treatment of relapsed or refractory Hodgkin disease. Am J Clin Oncol 2006, 29:189–195.

    Article  PubMed  Google Scholar 

  33. Josting A, Nogova L, Franklin J, et al.: Salvage radiotherapy in patients with relapsed and refractory Hodgkin’s lymphoma: a retrospective analysis from the German Hodgkin Lymphoma Study Group. J Clin Oncol 2005, 23:1522–1529.

    Article  PubMed  Google Scholar 

  34. Behringer K, Josting A, Schiller P, et al.: Solid tumors in patients treated for Hodgkin’s disease: a report from the German Hodgkin Lymphoma Study Group. Ann Oncol 2004, 15:1079–1085.

    Article  PubMed  CAS  Google Scholar 

  35. Hutchings M, Loft A, Hansen M, et al.: Clinical impact of FDG-PET/CT in the planning of radiotherapy for early-stage Hodgkin lymphoma. Eur J Haematol 2007, 78:206–212.

    Article  PubMed  Google Scholar 

  36. Aleman BM, Girinsky T, van der Maazen RW, et al.: Quality control of involved-field radiotherapy in patients with advanced Hodgkin’s lymphoma (EORTC 20884). Int J Radiat Oncol Biol Phys 2005, 63:1184–1190.

    Article  PubMed  Google Scholar 

  37. Dühmke E, Diehl V, Loeffler M, et al.: Randomized trial with early-stage Hodgkin’s disease testing 30 Gy vs. 40 Gy extended field radiotherapy alone. Int J Radiat Oncol Biol Phys 1996, 36:305–310.

    Article  PubMed  Google Scholar 

  38. Eich HT, Staar S, Gossmann A, et al.: Centralized radiation oncologic review of cross-sectional imaging of Hodgkin’s disease leads to significant changes in required involved field—results of a quality assurance program of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2004, 58:1121–1127.

    Article  PubMed  Google Scholar 

  39. Montalban C, Garcia JF, Abraira V, et al.: Influence of biologic markers on the outcome of Hodgkin’s lymphoma: a study by the Spanish Hodgkin’s Lymphoma Study Group. J Clin Oncol 2004, 22:1664–1673.

    Article  PubMed  CAS  Google Scholar 

  40. Diehl V, Stein H, Hummel M, et al.: Hodgkin’s lymphoma: biology and treatment strategies for primary, refractory, and relapsed disease. Hematology (Am Soc Hematol Educ Program) 2003, 225–247.

  41. Eghbali H, Raemaekers J, Carde P: The EORTC strategy in the treatment of Hodgkin’s lymphoma. Eur J Haematol Suppl 2005, 135–140.

  42. Straus DJ, Portlock CS, Qin J, et al.: Results of a prospective randomized clinical trial of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy (RT) versus ABVD alone for stages I, II, and IIIA nonbulky Hodgkin disease. Blood 2004, 104:3483–3489.

    Article  PubMed  CAS  Google Scholar 

  43. Canellos GP, Anderson JR, Propert KJ, et al.: Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992, 327:1478–1484.

    Article  PubMed  CAS  Google Scholar 

  44. Duggan DB, Petroni GR, Johnson JL, et al.: Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin’s disease: report of an intergroup trial. J Clin Oncol 2003, 21:607–614.

    Article  PubMed  CAS  Google Scholar 

  45. Fabian CJ, Mansfield CM, Dahlberg S, et al.: Low-dose involved field radiation after chemotherapy in advanced Hodgkin disease. A Southwest Oncology Group randomized study. Ann Intern Med 1994, 120:903–912.

    PubMed  CAS  Google Scholar 

  46. Fermé C, Sebban C, Hennequin C, et al.: Comparison of chemotherapy to radiotherapy as consolidation of complete or good partial response after six cycles of chemotherapy for patients with advanced Hodgkin’s disease: results of the Groupe d’Etudes des Lymphomes de l’Adulte H89 trial. Blood 2000, 95:2246–2252.

    PubMed  Google Scholar 

  47. Fermé C, Mounier N, Casasnovas O, et al.: Long-term results and competing risk analysis of the H89 trial in patients with advanced-stage Hodgkin lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Blood 2006, 107:4636–4642.

    Article  PubMed  CAS  Google Scholar 

  48. Horning SJ, Williams J, Bartlett NL, et al.: Assessment of the Stanford V regimen and consolidative radiotherapy for bulky and advanced Hodgkin’s disease: Eastern Cooperative Oncology Group pilot study E1492. J Clin Oncol 2000, 18:972–980.

    PubMed  CAS  Google Scholar 

  49. Diehl V, Brillant C, Franklin J, et al.: BEACOPP chemotherapy for advanced Hodgkin’s disease: results of further analyses of the HD9-and HD12-Trials of the German Hodgkin Study Group (GHSG) [abstract]. Blood (ASH Annual Meeting Abstracts) 2004, 104:Abstract 307.

  50. Radford JA, Rohatiner AZ, Ryder WD, et al.: ChlVPP/EVA hybrid versus the weekly VAPEC-B regimen for previously untreated Hodgkin’s disease. J Clin Oncol 2002, 20:2988–2994.

    Article  PubMed  CAS  Google Scholar 

  51. Gobbi PG, Levis A, Chisesi T, et al.: ABVD versus modified Stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate-and advanced-stage Hodgkin’s lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi. J Clin Oncol 2005, 23:9198–9207.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Volker Diehl MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aleman, B.M.P., Re, D. & Diehl, V. The role of radiation therapy in patients with Hodgkin’s lymphoma. Curr Hematol Malig Rep 2, 151–160 (2007). https://doi.org/10.1007/s11899-007-0021-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-007-0021-3

Keywords

Navigation