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
- 27 October 2006
- journal article
- research article
- Published by Elsevier BV in Annals Of Oncology
- Vol. 18 (2), 357-363
- https://doi.org/10.1093/annonc/mdl379
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
This publication has 34 references indexed in Scilit:
- Hodgkin's Lymphoma in Elderly Patients: A Comprehensive Retrospective Analysis From the German Hodgkin's Study GroupJournal of Clinical Oncology, 2005
- Involved-Field Radiotherapy Is Equally Effective and Less Toxic Compared With Extended-Field Radiotherapy After Four Cycles of Chemotherapy in Patients With Early-Stage Unfavorable Hodgkin’s Lymphoma: Results of the HD8 Trial of the German Hodgkin’s Lymphoma Study GroupJournal of Clinical Oncology, 2003
- Hodgkin’s disease in elderly patients (≥60): Clinical outcome and treatment strategiesInternational Journal of Radiation Oncology*Biology*Physics, 2003
- Hodgkin’s Disease in the Elderly: Improved Treatment Outcome With a Doxorubicin-Containing RegimenJournal of Clinical Oncology, 2002
- Prevalence of co-morbidity and its relationship to treatment among unselected patients with Hodgkin's disease and non-Hodgkin's lymphoma, 1993-1996Annals of Hematology, 1999
- Hodgkin disease in the elderly. A registry-based analysisCancer, 1992
- The prognosis of Hodgkin's disease in older adults.Journal of Clinical Oncology, 1991
- Treatment outcome in Hodgkin's disease in patients above the age of 60: A population-based studyAnnals of Oncology, 1991
- Hodgkin's disease and age*European Journal of Haematology, 1989
- Hodgkin's Disease in Patients Over Sixty Years OldAnnals of Internal Medicine, 1984