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Hodgkin Lymphoma: the Changing Role of Radiation Therapy in Early-Stage Disease—the Role of Functional Imaging

  • David J. Iberri
  • Richard T. Hoppe
  • Ranjana H. AdvaniEmail author
Lymphoma (JW Sweetenham, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lymphoma

Opinion Statement

Early-stage classical Hodgkin lymphoma (CHL) is a highly curable malignancy. Historically, extended-field radiotherapy (EFRT) alone showed excellent cure rates, but the risk of radiotherapy (RT)-associated toxicities led to combined modality therapy (CMT) replacing RT alone. RT has subsequently evolved further with significant reductions of dose and field size, and is currently restricted to involved sites only (ISRT). Contemporary CMT yields cure rates in excess of 85 %, and most studies do not have adequate follow-up required to evaluate the risk reduction in late effects. In an effort to avoid RT altogether, response-adapted treatment approaches utilizing results of interim [18F]fluorodeoxyglucose (FDG) positron emission tomography with fused computed tomography (PET/CT) imaging have been studied. Results from two studies in favorable-risk (UK RAPID and EORTC H10F) and one in unfavorable-risk patients (EORTC H10U) suggest that omission of RT in patients with a negative interim PET/CT response (Deauville score ≤2) yields slightly inferior progression-free survival (PFS) compared to conventional CMT, but with no difference in overall survival (OS) albeit with short-term follow-up. In order to extrapolate results to daily practice, it is critical to understand the selection of patients entered on trials since definitions of favorable and unfavorable disease vary between study groups. Currently, CMT continues to be the standard of care for the vast majority of patients with early-stage CHL and RT is an integral part of therapy in patients with bulky disease. However, for selected patients with favorable characteristics, emerging data suggest that a chemotherapy-alone approach is reasonable.

Keywords

Classical Hodgkin lymphoma Response-adapted therapy Positron emission tomography Combined modality therapy Radiotherapy 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

David J. Iberri declares that he has no conflict of interest.

Richard T. Hoppe declares that he has no conflict of interest.

Ranjana H. Advani has received institutional research funding from Seattle Genetics and Millennium Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • David J. Iberri
    • 1
  • Richard T. Hoppe
    • 2
  • Ranjana H. Advani
    • 3
    Email author
  1. 1.Department of Medicine, Divisions of Hematology and OncologyStanford University Medical CenterStanfordUSA
  2. 2.Department of Radiation OncologyStanford University Medical CenterStanfordUSA
  3. 3.Department of Medicine, Division of OncologyStanford University Medical CenterStanfordUSA

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