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

• Published in: Journal of clinical oncology Vol. 23; no. 7; pp. 1522 - 1529
• Main Authors: JOSTING, Andreas, NOGOVA, Lucia, DIEHL, Volker, ENGERT, Andreas, FRANKLIN, Jeremy, GLOSSMANN, Jan-Peter, EICH, Hans Theodor, SIEBER, Markus, SCHOBER, Thomas, BOETTCHER, Heinz-Dietrich, SCHULZ, Ulrich, MÜLLER, Rolf-Peter
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01-03-2005; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bleomycin - therapeutic use; Cyclophosphamide - therapeutic use; Dacarbazine - therapeutic use; Doxorubicin - therapeutic use; Etoposide - therapeutic use; Female; Hematologic and hematopoietic diseases; Hodgkin Disease - drug therapy; Hodgkin Disease - radiotherapy; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Prednisone - therapeutic use; Procarbazine - therapeutic use; Radiotherapy - adverse effects; Retrospective Studies; Salvage Therapy - adverse effects; Survival Rate; Treatment Failure; Tumors; Vinblastine - therapeutic use; Vincristine - therapeutic use; Europe; Germany; Human; Relapse; Treatment resistance; Cancerology; Treatment; Lymphoproliferative syndrome; Hodgkin disease; Malignant hemopathy; Radiotherapy; Lymphoma; Retrospective
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2005.05.022

To evaluate treatment outcome and prognostic factors in patients with refractory or first relapsed Hodgkin's disease (HD) treated with salvage radiotherapy (SRT) alone.
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.
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.
SRT offers an effective treatment for selected subsets of patients with relapsed or refractory HD.