Current Role and Future Developments of Radiotherapy in Early-stage Favourable Hodgkin's Lymphoma

Abstract

Strahlentherapie und Onkologie Supplement Article IntroductionThe radiosensibility of Hodgkin's lymphoma (HL) is well established since 1902, when Pusey [1] was one of the first to publish about radiotherapeutical treatment of a HL.In the early years, radiotherapy was the only curative treatment for this systemic disease, but the reports of Kaplan and Rosenberg [2] and Peters [3] in the fifties and seventies showed that irradiation of involved lymph node regions only resulted in high local and distant recurrences.The introduction of linear accelerator based high dose extended field (EF)-radiotherapy by Kaplan in Stanford was a milestone in the evolution of definitive curative radiotherapy strategies. The application of the mantle field for supradiaphragmatic and the inverted Y (with or without including the spleen or splenic pedicle) for infradiaphragmatic disease resulted in a dramatic improvement of survival rates in the early stages I and II (Ann Arbor) from 25-30 % in the sixties to 65-80 % in the eighties [4]. Kaplan reported about a close relationship between radiation dose and cure rates in the case of definitive radiotherapy. A dose of at least 40 Gy resulted in local recurrences below 5% and is today the standard dose for radiotherapy only outside protocols. Despite complete remission rates after radiotherapy of 90-100%, the overall recurrence rate (including in-field, marginal and distant relapses) was between 20 and 30%. Analysis of the relapses revealed some stage migrating risk factors: large mediastinal mass, extra nodal involvement, number of involved lymph node areas (> 3) and high ESR.The possibility of more accurate staging by using new imaging techniques like ultrasonography, CT and MRI as well as PET in the recent years resulted e.g. in the definition of early-favourable, early-unfavourable (intermediate) and high risk stages and more specific, risk adapted treatment strategies.The objective of this article is to show recent achievements and developments in the management of early-stage favourable HL exemplified by the strategy of the German Hodgkin Study Group (GHSG), where radiotherapy still is an integral part within combined modality treatment.

The addition of radiotherapy to chemotherapy does not improve outcome of early stage Hodgkin’s lymphoma patients: a retrospective long-term follow-up analysis of a regional Italian experience

“…There were no differences in the overall survival and second neoplasia-free survival of CT and CT+RT patients in our study; however, the small number of patients in our cohort may have prevented us from identifying a statistically significant difference. Innovative techniques, such as 3-D radiotherapy or radiotherapy with modulated intensity, may reduce the early and late toxic effects [14,[24][25][26], although results must be confirmed by controlled studies. Chemotherapy alone proved to be effective and can be used in early stage HL patients when RT is not available or when patients or physicians decide to exclude it from the first line approach.…”

Nodal Follicular Lymphoma

“…To date, there is no definitive evidence that the prognosis of early-stage FL can be improved by the use of target volumes larger than involved field. As in Hodgkin's disease [6,7], the international literature for FL [53,54] and updated guidelines of the National Comprehensive Cancer Network recommend IFI, while EFI is regarded as optional therapy. Increased PFS after EFI/TLI did not translate into superior OS when compared to IFI because of increased toxicity/mortality and secondary malignancies.…”

Complete Remission of a Lymphoma-Associated Chylothorax by Radiotherapy of the Celiac Trunk and Thoracic Duct

“…Due to the high intrinsic radiosensitivity of lymphomas mediastinal radiotherapy represents a valid treatment option, although clinical data are very limited [12,13]. Corresponding to the results of the German Hodgkin Study Group [11], additive radiotherapy in the area of bulky disease could be useful for patients with no complete remission after chemotherapy and is still an integral part within combined-modality treatment [2,9].…”