What are the long-term outcomes for early-stage HL patients who received radiotherapy alone or combined with chemotherapy?

This study determined long-term risk of death from all causes using data from 1,541 early-stage (stage 1-2) Hodgkin’s lymphoma (HL) patients who received radiotherapy (RT) alone or RT with chemotherapy. This study concluded that this risk was significantly lower for patients treated in the most recent era of radiation therapy thanks to improved treatment standards and higher cure rates.

Advances in treatments during the past four decades have led to significant improvements in survival for HL patients. Most early-stage HL patients are cured. Early-stage HL treatment has shifted from extended-field RT to ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine) and RT with smaller fields of radiation.

However, long-term side effects from outdated treatments, second cancers, and heart disease have been seen in early-stage patients treated 20 years ago or more. Risk of death from these factors remains high even 40 years after treatment, even for patients being treated today. The causes of death for these early-stage patients remain under investigation.

This study involved 1,541 early-stage HL patients. These patients were divided into three groups based on treatment year: 1968 – 1982 (492 patients), 1983 – 1992 (438 patients), and 1993 – 2007 (611 patients). Patients received RT with or without ABVD, ABVD-based, or MOPP (mechlorethamine, vincristine, prednisone, procarbazine) chemotherapy. The average follow-up period was 15.2 years.

25.6% of all patients died during the study period. Second cancers were the most common cause of death (11%), followed by HL (6%) and cardiac (5%) or pulmonary (1%) events. Lung cancer (18%), non-HL (13%), breast cancer (10%), and leukemia (9%) were the most common second cancers.

There was a statistically significant difference in overall survival (OS; time from treatment until death from any cause) by year of treatment. The OS rates at 10 years were 84% (1968 – 1982), 91% (1983 – 1992), and 92% (1993 – 2007). The OS rates at 15 years were 78% (1968 – 1982), 85% (1983 – 1992), and 88% (1993 – 2007).

During the first 10 years of follow-up, age at diagnosis (40 or older) was associated with a 5.07-fold increase in risk of death. This was statistically significant. B-symptoms (night sweats, fever, and fatigue) and non-ABVD chemotherapy regimens were also associated with an increased risk of death, but these were not significant.

This study concluded that mortality risk was significantly lower for patients treated in the most recent era of radiation therapy thanks to improved treatment standards and higher cure rates.

This study looked back in time to analyze data, so the collected data may be incomplete. Most patients in this study treated with outdated therapies, so these results may not be relevant for HL patients undergoing treatment today. Also, this study’s analysis limited the follow-up period to 10 years. This is because follow-up periods for patients treated decades ago may differ from patients being treated today. Future studies with longer follow-up periods are needed to determine the best follow-up strategies for early-stage HL survivors.

If you have early-stage Hodgkin’s lymphoma, talk to your care team about the benefits and drawbacks of combining RT with chemotherapy.