Originally published as JCO Early Release 10.1200/JCO.2005.05.022 on January 4 2005

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Salvage Radiotherapy in Patients With Relapsed and Refractory Hodgkin’s Lymphoma: A Retrospective Analysis From the German Hodgkin Lymphoma Study Group

From the First Department of Internal Medicine and Clinic of Radiotherapy, University Hospital Cologne, and the German Hodgkin Lymphoma Study Group (GHSG), Cologne; Department of Radiotherapy, University Hospital Frankfurt, Frankfurt; and the Clinic of Radiotherapy, City Hospital Krefeld, Krefeld, Germany.

Address reprint requests to Andreas Josting, MD, First Department of Internal Medicine, University Hospital Cologne, Joseph-Stelzmann-Str 9, 50924 Cologne, Germany; e-mail: andreas.josting{at}uni-koeln.de

PURPOSE: To evaluate treatment outcome and prognostic factors in patients with refractory or first relapsed Hodgkin’s disease (HD) treated with salvage radiotherapy (SRT) alone.

PATIENTS AND METHODS: From 4,754 patients registered in the database of the German Hodgkin Study Group from 1988 to 1999, 624 patients were identified with progressive disease (n = 202), or with early (n = 170) or late (n = 252) relapsed HD. At first treatment failure, SRT alone was given to 100 patients. Patient characteristics were: median age, 36 years; progressive disease, 47%; early relapse, 23%; late relapse, 30%; and "B" symptoms, 14%. Eighty-five percent of the patients relapsed after cyclophosphamide, vincristine, procarbazine, and prednisone/doxorubicin, bleomycin, vinblastine, and dacarbazine (COPP/ABVD) –like regimens; 8% after bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) regimens, 7% after first-line radiotherapy alone.

RESULTS: The volume irradiated was mantle field in 43% of patients, inverted-Y in 8%, total nodal irradiation in 12%, and involved-field in 37%. The median SRT dose was 40 Gy (range, 15 to 50 Gy). Seventy-seven patients achieved a complete remission and four patients achieved a partial remission. The 5-year freedom from treatment failure and overall survival (OS) rates were 28% and 51%, respectively. In multivariate analysis, significant prognostic factors for OS were B symptoms (P = .018) and stage at relapse (P = .014). For freedom from second failure (FF2F) Karnofsky performance status (P = .0001) was significant. In patients with limited stage at progression/relapse, duration of first remission was significant (P = .04) for FF2F.

CONCLUSION: SRT offers an effective treatment for selected subsets of patients with relapsed or refractory HD.

Supported by a grant from the Bundesministerium für Forschung und Technologie (BMFT) and by a grant from the Deutsche Krebshilfe.

A.J. and L.N. contributed equally to this work.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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