Is radiation necessary in early-stage favorable Hodgkin lymphoma

This trial compared the safety and effectiveness of treatment with ABVD chemotherapy with or without radiation and radiation alone in patients with early-stage (stage I or II) Hodgkin lymphoma. The authors concluded that ABVD alone was associated with a higher overall survival (time from treatment until death due to any cause) rate. This was due to the lower rate of death due to causes other than Hodgkin lymphoma.

The standard treatment option for early-stage Hodgkin lymphoma is ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy followed by radiation. This treatment combination has led to very high remission (no sign of disease) rates. However, radiation is associated with a number of long-term risks, including second cancers and cardiovascular disease.

It was previously reported that there was no difference in 4-year survival between patients treated with ABVD plus radiation and those treated with ABVD alone. It is not clear whether there would be differences in survival after a longer time period.

The current study reported the long-term survival rates in patients who were treated with ABVD chemotherapy alone. 399 patients were included in the study. 196 were randomly assigned to be treated with ABVD alone. 203 were treated with both ABVD and radiation. The average follow-up was 11.3 years.

The 12-year overall survival rates were higher in the ABVD only group (94%) compared to the ABVD plus radiation group (87%). However, there was a lower rate of freedom from progression in the ABVD group (87%) compared to ABVD plus radiation (92%).

12 patients who were treated with ABVD alone died. 6 died due to Hodgkin lymphoma and 6 died due to other causes. In the radiation plus ABVD group, 24 patients died. 6 died due to Hodgkin lymphoma and 20 died due to other causes.

This study concluded that ABVD therapy on its own was associated with better overall survival, due to the lower rate of death from other causes.

This study originally stopped recruiting because another trial reported the high effectiveness of the chemotherapy/radiation combination. This long-term follow-up was not originally part of the study. 

This study was originally published in 2012, when larger areas of the body were treated with radiation. Current treatment options include more focused areas of radiation.