Combination Chemotherapy Plus Involved-field Radiotherapy For Early-stage Hodgkin's Lymphoma:Effects On Outcome And Long-term Complications

Purpose:To evaluate the early and late toxicities and long-term survival of chemotherapy followed by involved-field radiotherapy (IF-RT) for patients with early-stage Hodgkin lymphoma (HL).Methods and Materials:From2000to2008,161pathologically proved stage I-II HL patients received combination chemotherapy followed by IF-RT. Thirty-five patients had stage I disease and126patients had stage II disease. According to EORTC criteria,95(59%) patients were classified as unfavorable group. According to the prognostic group, patients received4to6cycles of chemotherapy followed by involved-field radiotherapy. The majority of patients (95%) were treated with ABVD. The radiation dose was30to40Gy. Acute and late toxicities were scored separately. The local control (LC), overall survival (OS), and progression-free survival (PFS) were calculated using the Kaplan-Meier method.Results:Grade â…¢-â…£ toxicities during chemotherapy and radiotherapy were observed in34.8%and2.5%of all patients, respectively. The Grade III and IV acute toxicities included bone marrow suppression, gastrointestinal toxicities, and alopecia during chemotherapy, and leucopenia and mucositis during radiotherapy. With the median follow-up of58.5months, the5-year OS, LC and PFS was97.5%,98%and93.3%, respectively. Twelve patients (7.5%) had disease recurrence or progression. Two patients had in-field relapse,7had out-field relapse, and3had in-field and out-field relapse simultaneously. Late treatment-related toxicities greater than Grade2included cardiovascular disease (n=5), symptomatic pneumonia (n=2), xerostomia (n=2), chemotherapy-induced vasculitis (n=1), and secondary neoplasms (n=2).Conclusions:Patients with early-stage Hodgkin's lymphoma who received chemotherapy and involved-field radiotherapy had a favorable prognosis with excellent local control. The early and late treatment toxicities were rare. Purpose:The dosimetric and clinical outcomes of involved-field intensity-modulated radiotherapy (IF-IMRT) for early stage Hodgkin lymphoma (HL) following chemotherapy have not been previously reported. The purpose of this study was to evaluate the clinical outcome and toxicities of IF-IMRT for patients early stage HL with mediastinum involvement.Methods and Materials:Fifty-two patients with early stage mediastinum-involved HL were reviewed. Eight patients had stage I disease and44patients had stage â…¡ disease. Twenty three (44%) patients presented with bulky mediastinum, while forty two (81%) patients had involvement of both mediastinum and cervical or axillary. All patients received combination chemotherapy followed by IF-IMRT. The prescribed radiation dose was30-40Gy. The dose-volume histograms (DVH) of the target volume and critical normal structures were evaluated. The local control (LC), overall survival (OS), and progression-free survival (PFS) were calculated using the Kaplan-Meier method.Results:The median mean dose to the primary involved regions (planning target volume, PTV1) and boost area (PTV2) was37.5Gy and42.1Gy, respectively. Only0.4%and1.3%of the PTV1, and0.1%and0.5%of the PTV2received less than90%and95%of the prescribed dose, indicating the excellent PTV coverage. The median mean lung dose (MLD) and V20to the lungs were13.8Gy and25.9%, respectively. With a median follow-up time of36.3months, the3-year OS, LC and PFS rates were100%,97.9%and96%, respectively. No Grade4or5acute or late toxicity was reported. No symptomatic radiation-induced acute or late pneumonitis or heart injury was reported.Conclusions:Despite of large target volume, IF-IMRT for patients with early stage mediastinum-involved HL showed excellent dose coverage and a favorable prognosis with mild toxicity. BACKGROUND:Nasal diffuse large B-cell lymphoma (DLBCL) is rare. The purpose of this study was to evaluate the clinical features and treatment outcomes.METHODS:Twenty-five patients were included. All patients received combination chemotherapy with or without radiotherapy.RESULTS:Patients with nasal DLBCL were usually older and predominantly male, with early stage disease, low frequency of B symptoms and elevated lactate dehydrogenase (LDH), good performance status, and low-risk International Prognostic Index (IPI). The overall response rate after initial treatment was76%. The3-year overall survival (OS) rate for the whole group was44%; median OS was35months. Performance status and IPI were significant prognostic factors for OS. For patients in the IPI0-1group, the3-year OS rate and median OS were54%and52months vs.17%and11months for the IPI2-3group (P=0.033). The prognosis of patients who achieved complete response (CR) was significantly better than that of those who did not achieve CR. Extranodal spread was the primary pattern of failure.CONCLUSIONS:Primary nasal DLBCL appears to have distinct clinical features; its poor outcome and a propensity for extranodal failure illustrate the need for innovative therapies.