Long-Term Outcomes of Patients with Early-Stage Non-Bulky Hodgkin Lymphoma Treated with Combined Modality Therapy on the Stanford V Trials (The G4 and G5 Studies). International journal of radiation oncology, biology, physics Mou, E. n., Advani, R. H., von Eyben, R. n., Rosenberg, S. A., Hoppe, R. T. 2020


Combined modality therapy (CMT) is standard therapy for early-stage Hodgkin lymphoma (ESHL). We previously reported excellent outcomes with the abbreviated Stanford V regimen. Herein we report updated results with median follow-up >10 years on survival, therapy-related late effects, and impact of disease risk factors on patient outcomes.The XXXXXX and YYYYYY studies enrolled patients with stage I-IIA non-bulky ESHL. Patients received eight weeks of Stanford V chemotherapy followed by 30 Gy modified involved-field radiotherapy (mIFRT) (XXXXXX) or Stanford V-C + 20 Gy mIFRT (YYYYYY). Patients were categorized as favorable or unfavorable risk per German Hodgkin Study Group (GHSG) criteria and outcomes between groups compared.129 patients were enrolled (68 favorable and 61 unfavorable risk). In the XXXXXX study (n = 87), at median follow-up of 19.7 years, 5-, 10-, and 15-year PFS and OS were 95.4%/97.7%, 91.8%/96.5%, and 91.8%/95.3%, respectively. In the YYYYYY study (n = 42), at median follow-up of 13.5 years, the 5-, 10-, and 15-year PFS and OS were 92.9%/100%, 92.9%/100%, and 88.4%/91.9%, respectively. PFS (p = 0.86) and OS (p = 0.86) were not significantly different between studies. There were also no significant differences between studies in patients with favorable or unfavorable risk for PFS (F: p = 0.53; U: p = 0.96), OS (F: p = 0.99; U: p = 0.78), secondary malignancies (F: p = .74; U: p = 1.0), and cardiovascular complications (F: no cases; U: p = 1.0).The XXXXXX and YYYYYY studies achieve high rates of durable remission. 20 versus 30 Gy mIFRT and cyclophosphamide substituted for mechlorethamine did not compromise nodal control, PFS, or OS in both favorable and unfavorable risk disease. These results support the efficacy of CMT in early-stage disease and lower-dose radiotherapy in patients with favorable and non-bulky unfavorable ESHL.

View details for DOI 10.1016/j.ijrobp.2020.12.039

View details for PubMedID 33385495