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Rolle der Strahlentherapie beim Hodgkin-Lymphom

Role of radiotherapy in Hodgkin’s lymphoma

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Strahlentherapie hat in der Behandlung des Hodgkin-Lymphoms (HL) einen festen Stellenwert.

Methoden

Es erfolgte eine Literaturrecherche in der Datenbank PubMed über die Entwicklung und Bedeutung der Strahlentherapie im Rahmen der Behandlung des HL.

Ergebnisse

Die Bestrahlung des HL hat sich als feste Säule der Therapie über die letzten Jahrzehnte etabliert. In den Anfängen dominierte die alleinige Extended-Field-Radiotherapie (EF-RT). Remissionsraten von 90 % in frühen Stadien waren ein Beleg für die große Wirksamkeit der Bestrahlung. Allerdings konnte eine weitere Verbesserung des FFTF („freedom from treatment failure“) erst durch das Hinzufügen einer Polychemotherapie erreicht werden. Diese multimodalen Behandlungskonzepte wurden konsequent über Generationen in klinischen Studien geprüft, und so konnte eine kontinuierliche Reduktion der Bestrahlungsdosis und der Bestrahlungsvolumina bei gleicher bzw. besserer Wirksamkeit erfolgen. Die Reduktion der therapieassoziierten Nebenwirkungen rückte bei einem vorwiegend jungen Patientenkollektiv mit exzellenter Langzeitprognose immer mehr in den Vordergrund, und so sind aktuelle Studien insbesondere durch den Versuch der Therapiestratifizierung und die mögliche Reduktion der Behandlungsintensität geprägt.

Schlussfolgerung

Im Zeitalter der individualisierten Medizin wird die systemische Therapie weiter an Bedeutung gewinnen und zugleich die hohe lokale Wirksamkeit der konsolidierenden Radiotherapie als wesentliche Therapiekomponente bestehen bleiben („combined modality“).

Abstract

Background

Radiotherapy is a well-established element in the treatment of Hodgkin’s lymphoma.

Methods

An analysis of the literature in the database PubMed on the development and importance of radiotherapy within the framework of treatment of Hodgkin’s lymphoma was performed.

Results

Over the last century radiotherapy has been shown to be the most effective single modality in the treatment of Hodgkin’s lymphoma. In the beginning extended field radiotherapy (EF-RT) was commonly used and induced remission rates of 90 % in early stage Hodgkin’s lymphoma. However, further improvement of freedom from treatment failure (FFTF) could only be achieved through the addition of polychemotherapy. This multimodal treatment concept has been rigorously tested over many generations in clinical trials leading to continuous reduction in the radiation dose and target volume with the same or better efficiency. More recent studies focused on reducing therapy-associated side effects especially in young patients who have an excellent long-term prognosis, by attempting to stratify treatment with possible reduction in therapy intensity.

Conclusion

In the era of personalized medicine, treatment regimes will focus on targeted systemic therapy but will still rely on highly effective consolidating radiotherapy (combined modality).

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Literatur

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

    Article  PubMed  Google Scholar 

  2. André Marc PE, Reman O, Federico M, Girinski T et al (2012) Interim analysis of the randomized Eortc/Lysa/Fil intergroup H10 trial on early PET-scan driven treatment adaptation in stage I/II Hodgkin lymphoma, abstract at int. Congress of American Society of Haematology (ASH)

  3. Borchmann P, Haverkamp H, Diehl V et al (2011) Eight cycles of escalated-dose BEACOPP compared with four cycles of escalated-dose BEACOPP followed by four cycles of baseline-dose BEACOPP with or without radiotherapy in patients with advanced-stage Hodgkin’s lymphoma: final analysis of the HD12 trial of the German Hodgkin Study Group. J Clin Oncol 29:4234–4242. doi:10.1200/JCO.2010.33.9549

    Article  CAS  PubMed  Google Scholar 

  4. Cosset JM, Henry-Amar M, Meerwaldt JH (1991) Long-term toxicity of early stages of Hodgkin’s disease therapy: the EORTC experience. EORTC Lymphoma Cooperative Group). Ann Oncol 2(Suppl 2):77–82

    Article  PubMed  Google Scholar 

  5. Eich HT, Diehl V, Gorgen H et al (2010) Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin’s lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol 28:4199–4206

    Article  PubMed  Google Scholar 

  6. Eich HT, Müller RP, Engenhart-Cabillic R et al (2008) Involved-node radiotherapy in early-stage Hodgkin’s lymphoma. Definition and guidelines of the German Hodgkin Study Group (GHSG). Strahlenther Onkol 184):406–410

    Article  PubMed  Google Scholar 

  7. Ekstrand BC, Lucas JB, Horwitz SM et al (2003) Rituximab in lymphocyte-predominant Hodgkin disease: results of a phase 2 trial. Blood 101:4285–4289

    Article  CAS  PubMed  Google Scholar 

  8. Engert A, Franklin J, Eich HT et al (2007) Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin’s lymphoma: final results of the GHSG HD7 trial. J Clin Oncol 25:3495–3502

    Article  CAS  PubMed  Google Scholar 

  9. Engert A, Haverkamp H, Kobe C et al (2012) Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin’s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 379:1791–1799

    Article  CAS  PubMed  Google Scholar 

  10. Engert A, Plutschow A, Eich HT et al (2010) Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med 363:640–652

    Article  CAS  PubMed  Google Scholar 

  11. Engert A, Schiller P, Josting A et al (2003) 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 21:3601–3608

    Article  PubMed  Google Scholar 

  12. Ferme C, Eghbali H, Meerwaldt JH et al (2007) Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med 357:1916–1927

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. Herbst C, Rehan FA, Skoetz N et al (2011) Chemotherapy alone versus chemotherapy plus radiotherapy for early stage Hodgkin lymphoma. Cochrane Database Syst Rev CD007110

  15. Hoskin PJ, Smith P, Maughan TS, Gilson D et al (2005) Long-term results of a randomised trial of involved field radiotherapy vs extended field radiotherapy in stage I and II Hodgkin lymphoma. Clin Oncol (R Coll Radiol) 17:47–53

    Google Scholar 

  16. Kobe C, Dietlein M, Franklin J et al (2008) Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma. Blood 112:3989–3994

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Meyer RM, Gospodarowicz MK, Connors JM et al (2005) 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 23:4634–4642

    Article  CAS  PubMed  Google Scholar 

  18. Meyer RM, Gospodarowicz MK, Connors JM et al (2011) ABVD alone versus radiation-based therapy in limited-stage Hodgkin’s lymphoma. N Engl J Med 366:399–408

    Article  PubMed  PubMed Central  Google Scholar 

  19. Murphy SB, Morgan ER, Katzenstein HM, Kletzel M (2003) Results of little or no treatment for lymphocyte-predominant Hodgkin disease in children and adolescents. J Pediatr Hematol Oncol 25:684–687

    Article  PubMed  Google Scholar 

  20. Nogova L, Reineke T, Brillant C et al (2008) Lymphocyte-predominant and classical Hodgkin’s lymphoma: a comprehensive analysis from the German Hodgkin Study Group. J Clin Oncol 26:434–439

    Article  PubMed  Google Scholar 

  21. Nogova L, Reineke T, Eich HT et al (2005) Extended field radiotherapy, combined modality treatment or involved field radiotherapy for patients with stage IA lymphocyte-predominant Hodgkin’s lymphoma: a retrospective analysis from the German Hodgkin Study Group (GHSG). Ann Oncol 16:1683–1687

    Article  CAS  PubMed  Google Scholar 

  22. Radford J, Sally Barrington S, Counsell N et al (2012) Involved field radiotherapy versus no further treatment in patients with clinical stages IA and IIA Hodgkin lymphoma and a ‚Negative‘ PET scan after 3 cycles ABVD. results of the UK NCRI RAPID trial, abstract at int. Congress of American Society of Haematology (ASH)

  23. Rosenberg SA, Kaplan HS (1986) The evolution and summary results of the Stanford randomized clinical trials of the management of Hodgkin’s disease: 1962–1984. Int J Radiat Oncol Biol Phys 11:5–22

    Article  Google Scholar 

  24. Schulz H, Rehwald U, Morschhauser F et al (2008) Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood 111:109–111

    Article  CAS  PubMed  Google Scholar 

  25. Specht L, Yahalom J, Illidge T et al (2013) Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys pii: S0360-S3016(13)005348. doi:10.1016/j.ijrobp.2013.05.005. (Epub ahead of print)

    Google Scholar 

  26. Tresckow B von, Plütschow A, Fuchs M, Klimm B et al (2012) Dose-intensification in early unfavorable Hodgkin’s lymphoma: final analysis of the German Hodgkin Study Group HD14 trial. J Clin Oncol 30:907–913

    Article  Google Scholar 

  27. Engert A, Schiller P, Josting A et al (2003) 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. 21:3601-3608

    Google Scholar 

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. C.M. Baues, R. Semrau, B. Nast-Kolb und H.T. Eich geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    C.M. Baues, R. Semrau & B. Nast-Kolb

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster, Münster, Deutschland

    H.T. Eich

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  1. C.M. Baues
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  2. R. Semrau
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  3. B. Nast-Kolb
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  4. H.T. Eich
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Correspondence to C.M. Baues.

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Baues, C., Semrau, R., Nast-Kolb, B. et al. Rolle der Strahlentherapie beim Hodgkin-Lymphom. Onkologe 20, 441–447 (2014). https://doi.org/10.1007/s00761-013-2635-5

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  • DOI: https://doi.org/10.1007/s00761-013-2635-5

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