Rolf-Peter Mueller MD, PhD, Presenter: Nothing to Disclose

Hans-T Eich MD, PhD, Abstract Co-Author: Nothing to Disclose

The optimal treatment for elderly patients with Hodgkin lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact and toxicity of different radiation field sizes, i.e. extended field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy.

In the multicenter HD8 study of the German Hodgkin Study Group (GHSG), 1204 patients with early-stage unfavorable HL were randomized to receive to four cycles of chemotherapy (two double cycles COPP/ABVD) followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulk disease (arm B). 1064 patients were evaluable for the analysis. Of these, 89 patients (8.4%) were 60 years or older.

Elderly patients had a different risk profile and more often presented with negative risk factors such as B symptoms, elevated ESR, and poorer performance status. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT (WHO °3/4: 25.7% v 8.6%). Freedom from treatment failure (FFTF) and overall survival (OS) at 5 years was lower in elderly patients (64% v 70%) compared with younger patients (87% v 94%). Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% v 70%; p<0.034) and OS (59% v 81%;p<0.008).

Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared to 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.

s.a.

Mueller, R, Eich, H, Elderly Patients with Hodgkin Lymphoma: Extended-Field Radiotherapy versus Involved-Field Radiotherapy after Chemotherapy.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5001592.html