Originally published as JCO Early Release 10.1200/JCO.2007.15.1001 on October 6 2008

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Involved-Nodal Radiation Therapy As a Component of Combination Therapy for Limited-Stage Hodgkin's Lymphoma: A Question of Field Size

Belinda A. Campbell, Nick Voss, Tom Pickles, James Morris, Randy D. Gascoyne, Kerry J. Savage, Joseph M. Connors

From the Departments of Radiation Oncology, Pathology, and Medical Oncology, British Columbia Cancer Agency; and the University of British Columbia, Vancouver, Canada

Corresponding author: Belinda A. Campbell, MBBS, FRANZCR, British Columbia Cancer Agency, 600 West 10th Ave, Vancouver, British Columbia, Canada; e-mail: Bcampbell3{at}bccancer.bc.ca

Purpose Combined-modality therapy is the standard of care for limited-stage Hodgkin's lymphoma (HL). Radiation therapy has evolved from extended-field radiation therapy (EFRT) to involved-field radiation therapy (IFRT), reducing toxicity while maintaining high cure rates. Recent publications recommend a further reduction to involved-nodal radiation therapy (INRT), however, this has not been clinically validated.

Patients and Methods We identified 325 patients with limited-stage HL, diagnosed between May 1, 1989 and April 1, 2005, and treated with chemotherapy and radiation therapy following era-specific guidelines: EFRT until 1996; IFRT from 1996 to 2001; INRT 5 cm from 2001 to the present. INRT 5 cm was defined as the prechemotherapy nodal volume with margins 5 cm to account for physiological movement, set-up variation, and the limitations of conventional simulation and radiation therapy techniques. Exclusion criteria were age younger than 16, fluorine-18 fluorodeoxyglucose positron emission tomography, non–doxorubicin, bleomycin, vinblastine, and dacarbazine-like chemotherapy, and/or more than four chemotherapy cycles.

Results At diagnosis, median age was 35 years; 52% male; stage IA 29%; stage IIA 71%. Ninety-five percent of patients received two chemotherapy cycles. The three radiation therapy groups were: EFRT, 39%; IFRT, 30%; and INRT 5 cm, 31%. Median follow-up of living patients was 80 months. Median time to relapse was 37 months. Twelve relapses occurred: four after EFRT (3%); five after IFRT (5%); and three after INRT 5 cm (3%; P = .9). No marginal recurrences occurred after INRT 5 cm. Locoregional relapse (LRR) occurred in five patients: three after EFRT; two with IFRT; and none with INRT 5 cm. At 5 years, progression-free survival (PFS) was 97%, and overall survival (OS) was 95%. At 10 years, PFS and OS were 95% and 90%, respectively.

Conclusion Reduction in field size appears to be safe, without an increased risk of LRR in patients receiving INRT 5 cm.

published online ahead of print atwww.jco.org on October 6, 2008

Supported in part by generous donations from the Turner Family Fund for Lymphoma Research, the Porte Endowment for Lymphoma Research, and the Centre for Lymphoid Cancer of the British Columbia Cancer Agency.

Presented in part at the 14th European Cancer Conference, Barcelona, Spain, September 23-27, 2007.

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

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