Annals of Oncology Advance Access originally published online on October 27, 2006
Annals of Oncology 2007 18(2):357-363; doi:10.1093/annonc/mdl379
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© 2006 European Society for Medical Oncology
hematologic malignancies |
Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin's lymphoma: an analysis from the German Hodgkin Study Group
1 Department I of Internal Medicine
2 Department of Radiation Oncology
3 Coordination Center for Clinical Trials (KKSK), University Hospital Cologne, Cologne
4 Canton Hospital, Basel, Switzerland
5 University Clinic Münster, Münster
6 University Clinic Nürnberg, Nürnberg
7 Hospital Bottrop, Bottrop
8 University Clinic Mannheim, Mannheim
9 Department of Radiation Oncology, Ludwig Maximilian University München, Munich
10 Department of Pathology, University Hospital Würzburg, Würzburg; German Hodgkin Study Group, Germany
* Correspondence to: Dr B. Klimm, Department I of Internal Medicine, Kerpener Street 62, University Hospital Cologne, 50924 Cologne, Germany. Tel: +49-0-221-478-5933; Fax: +49-0-221-478-3778; E-mail: beate.klimm{at}uk-koeln.de
Background: The optimal treatment of elderly patients with Hodgkin's lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy.
Patients and methods: In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older.
Results: Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008).
Conclusion: Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoided.
Key words: clinical trial, elderly patients, Hodgkin lymphoma, outcome, radiotherapy
Received for publication August 27, 2006. Accepted for publication September 1, 2006.