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DOI: 10.1055/s-0034-1389928
Increased Relapse Rates in Early Stage Hodgkin Lymphoma (HL) Patients without Radiotherapy: The German Society of Radiooncology (DEGRO) Advises to Treat all Early Stage HL Patients with Radiotherapy
Publication History
Publication Date:
28 November 2014 (online)
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In the EORTC/LYSA/FIL H10 trial stage I/II HL patients with favorable and unfavorable risk profile and a negative 18-fluoro-desoxy-D-glucose positron emission tomography (FDG-PET) after 2 cycles of ABVD were randomized for radiotherapy (RT) vs. no radiotherapy after the end of chemotherapy. After an interim futility analysis the data monitoring and safety committee considered it unlikely to demonstrate non-inferiority of the experimental arm (with omission of RT) compared to the standard RT arm. Therefore the study was suspended. The decrease in the 1-year PFS with omission of RT was 3–5%, but absolute PFS was still in the range of 95%. The authors conclude their article “The final analysis will reveal whether this finding is maintained over time…. [5]”.
Recently, the German Society of Radiooncology (DEGRO) circulated a statement advising that all patients with early stage HL should receive RT based on the results of the H10 trial. Although the current evidence-based S3 guideline “Hodgkinʼs Lymphoma” of the German Cancer Society does advise involved-field radiotherapy with 20 Gy following chemotherapy for all patients over 18 years of age – if treated outside of clinical trials [11] – the general recommendation of radiotherapy for all HL patients cannot be extended to pediatric patients.
The strategy of the upcoming EuroNet-PHL-C2 trial stands in striking contrast to the DEGROʼs advice. In this upcoming trial the EuroNet-PHL group aims at a 5-year EFS rate of more than 90% and at omitting radiotherapy in early favourable HL patients with a negative FDG-PET result (Deauville score<4) after 2 cycles of OEPA. In addition, early favourable HL patients treated without RT will receive one additional cycle of COPDAC, a regimen with a low toxicity profile [3], to minimize the decrease of event-free survival (EFS; including second cancers as events) in patients without RT. It is expected that more than 90% of the early favourable HL patients will be PET negative. The patients with early unfavourable HL will be treated in group of intermediate stage patients. These patients will be randomized between standard COPDAC consolidation and an intensified DECOPDAC regimen. Again, patients who are PET-negative after 2 cycles of OEPA will not receive RT. In the light of the results of the H10 trial and the advice of the DEGRO the EuroNet-PHL group has to ask:
* For the GPOH-HD committee within the EuroNet-PHL group.
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References
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