Chemotherapy and radiation improve survival in early stage classical H odgkin lymphoma: A statewide cancer registry analysis
Year: 2017
Type: article
Study design: Observational Study
Abstract: Introduction: Early stage classical Hodgkin lymphoma (cHL) has been shown to have an excellent outcome. Recent studies have therefore focused on decreasing the toxicity that results from the addition of radiation therapy to chemotherapy. However, it remains unclear whether omitting radiation as part of the initial therapy of cHL is associated with a similar survival. The aim of this study is to investigate the outcomes observed in a statewide cancer registry for cHL patients treated with chemotherapy alone versus patients treated with chemotherapy and radiation. Methods: All adult patients (older than 18) diagnosed with cHL in Kentucky Cancer Registry (KCR) from 2005 to 2014 were retrospectively reviewed. Baseline characteristics (age at diagnosis, gender, histology, stage, B symptoms, extranodal involvement, and the site involved) were collected. First line treatment and overall survival outcomes were reviewed. Stage I and II patients without B symptoms were considered favorable, while those with B symptoms were considered unfavorable. Patients with stage III and IV disease were given an advanced stage designation. To adjust for selection bias, patient deaths during the first 6 months of diagnosis were censored for overall survival analysis. Results: A total of 961 patients were identified. Median age was 41 (range, 18-91), 60.9% (n = 585) were younger than 50, and 55.5% were males. Only 1.7% (n = 16) had extranodal involvement at presentation. Of those with known histology (78.6%), the most common was nodular sclerosis (71.2%), followed by mixed cellularity (22.8%), lymphocyte rich (3.8%), and lymphocyte depleted (1.9%). Median follow-up time was 45 months (range, 0-136). The 10-year overall survival for the favorable group (n = 329) was 77% (95% CI, 71.1-88.8) versus 68% for the unfavorable group (n = 144) and 42% for the advanced group (n = 372) (P < .001). There was no statistical difference in survival between stage I (n = 170), and stage II (n = 385) disease (P = .99). In the favorable risk group, those who received chemotherapy alone (n = 145) were compared to those who received combined chemotherapy and radiation (n = 148). The 10-year overall survival for the cohort receiving chemotherapy and radiation was 87% compared to 75% for those receiving only chemotherapy (P < .001) (Figure 1). When adjusted by multivariate analysis for risk factors affecting 10 year survival of the favorable cohort, only age < 50 and the treatment modality were independently associated with a statistically significant difference in overall survival [HR of 0.11 (P < .001) and 3.94 (P = .001), respectively]. Conclusion: Our large data cohort shows the presence of B symptoms was more prognostic than the number of nodal regions involved for early stage disease. Although the use of radiation as part of initial therapy for early stage disease might have increase long-term toxicity, it continued to provide superior survival at 10 years. Keywords: Chemotherapy; Hodgkin lymphoma (HL)
Source: Hematological Oncology
DOI: 10.1002/hon.2439_55
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2621953098