Early-Stage Classic Hodgkin Lymphoma: The Utilization of Radiation Therapy and Its Impact on Overall Survival

• Published in: International journal of radiation oncology, biology, physics Vol. 93; no. 3; pp. 684 - 693
• Main Authors: Parikh, Rahul R., MD, Grossbard, Michael L., MD, Harrison, Louis B., MD, Yahalom, Joachim, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2015
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Confidence Intervals; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; Hodgkin Disease - mortality; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Humans; LYMPHOMAS; Male; Middle Aged; PATIENTS; Propensity Score; Proportional Hazards Models; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy - utilization; Retrospective Studies; Socioeconomic Factors; SURVIVAL CURVES; Young Adult
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2015.06.039

Purpose To examine the association between radiation therapy (RT) utilization and overall survival (OS) for patients with early-stage Hodgkin lymphoma (HL). Methods and Materials Using the National Cancer Database, we evaluated clinical features and survival outcomes among patients diagnosed with stage I/II HL from 1998 to 2011. The association between RT use, covariables, and outcome was assessed in a Cox proportional hazards regression model. Propensity score matching was performed to balance observed confounding factors. Survival was estimated using the Kaplan-Meier method. Results Among the 41,943 patients in the National Cancer Database with stage I/II HL, 29,752 patients were analyzed for this study. Radiation therapy use was associated with younger age (≤40 years), favorable insured status, higher socioeconomic status (income, education), and treatment at comprehensive community cancer centers (all P <.05). Five-year OS for patients receiving RT was 94.5%, versus 88.9% for those not receiving RT ( P <.01). Radiation therapy use was a significant predictor of OS in the “As-Treated” cohort (hazard ratio 0.53, 95% confidence interval 0.49-0.58, P <.01) and intention-to-treat analysis ( P <.01). After propensity score matching based on clinicopathologic characteristics, RT use remained associated with improved OS (hazard ratio 0.46, 95% confidence interval 0.38-0.56, P <.01). Over the study period, RT utilization for this cohort decreased from 55% to 44%, most commonly because it was not part of the planned initial treatment strategy. Conclusions Consolidation RT was associated with improved OS for patients with early-stage classic HL. We also have identified patient-specific variations in the use of RT that may be targeted to improve patient access to care.