Does omitting radiotherapy improve outcomes for patients with early-stage Hodgkin lymphoma?

This study evaluated the outcomes of removing radiotherapy from treatment for patients with early-stage Hodgkin lymphoma (HL). This study concluded that radiotherapy improved survival without disease progression for patients while omitting it did not affect overall survival.

Chemotherapy followed by radiotherapy (RT) is the standard treatment for patients with early-stage HL. During treatment, PET scans are often used to see how well a patient is responding to therapy. A positive PET scan indicates that cancer cells are still present. This may indicate a poorer prognosis after treatment.

Some studies suggest that PET scanning can help guide treatment. For patients who respond well to chemotherapy, RT may be omitted to reduce side effects. Whether this approach leads to better outcomes compared to proceeding with RT is unclear.

This study looked at the results of 4 studies. These studies had a total of 2267 patients with early-stage HL. 1136 patients received RT, while 1131 patients did not. Patients were followed up from 4 to 10 years.

Fewer patients in the RT group had cancer recurrence compared to patients who did not have RT (4.7% vs. 11.2%). RT significantly lowered the risk of the cancer growing or spreading by 2.08-fold.

Among patients with favorable disease (needs less intense treatment), fewer patients in the RT group had cancer recurrence compared to patients who did not have RT (3.7% vs. 10.8%). For patients with favorable disease, RT significantly lowered the risk of the cancer growing or spreading by 2.77-fold.

Among patients with unfavorable disease (needs more intense treatment), fewer patients in the RT group had cancer recurrence compared to patients who did not have RT (6.7% vs. 12.0%). For patients with favorable disease, RT significantly lowered the risk of the cancer growing or spreading by 1.65-fold.

Patients who had non-bulky disease also benefitted from RT. For these patients, RT significantly lowered the risk of the cancer growing or spreading by 1.69-fold.

A separate analysis found that significantly fewer patients in the RT group had second-line therapy compared to patients who did not have RT (3.7% vs. 11.7%).

However, no difference in overall survival was seen between the RT group and the non-RT group.

This study concluded that RT improved survival for patients with early-stage HL. The authors suggest that using PET scans to guide the omission of RT did not affect survival outcomes for these patients.

This study looked at the results of four different studies. Data for individual patients was not available. More studies are needed to determine which groups of patients are less likely to benefit from RT.