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Annals of Oncology Advance Access published online on October 27, 2006
Annals of Oncology, doi:10.1093/annonc/mdl379
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© 2006 European Society for Medical Oncology
Received August 27, 2006
Accepted September 1, 2006

original article

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

B. Klimm 1 *, H. T. Eich 2, H. Haverkamp 3, A. Lohri 4, P. Koch 5, F. Boissevain 6, G. Trenn 7, P. Worst 8, E. Dühmke 9, R. P. Müller 2, K. Müller-Hermelink 10, B. Pfistner 3, V. Diehl 1, and A. Engert 1

1 Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
2 Department of Radiation Oncology, University Hospital Cologne, Cologne, Germany
3 Coordination Center for Clinical Trials (KKSK), University Hospital Cologne, Cologne, Germany
4 Canton Hospital, Basel, Switzerland
5 University Clinic Münster, Münster, Germany
6 University Clinic Nürnberg, Nürnberg, Germany
7 Hospital Bottrop, Bottrop, Germany
8 University Clinic Mannheim, Mannheim, Germany
9 Department of Radiation Oncology, Ludwig Maximilian University München, Munich, Germany
10 Department of Pathology, University Hospital Würzburg, Würzburg; German Hodgkin Study Group, Germany

* To whom correspondence should be addressed.
B. Klimm, E-mail: beate.klimm{at}uk-koeln.de


  Abstract

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.

Keywords: clinical trial; elderly patients; Hodgkin lymphoma; outcome; radiotherapy.
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