Involved Nodal Radiotherapy vs. Involved Field Radiotherapy after Chemotherapy in the Treatment of Early Stage Hodgkin’s Lymphoma


Aim of work: This study is a prospective randomized trial aiming to investigate whether radiotherapy volume can be reduced without loss of efficacy from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) after four cycles of ABVD chemotherapy in the treatment of early stage Hodgkin’s lymphoma. Patients and Methods: Between September 2009 and January 2012, all patients with newly diagnosed early-stage favorable and unfavorable Hodgkin’s lymphoma attending to the Clinical Oncology department of Cairo University, faculty of medicine were enrolled into this study after a written consent was obtained from those cases enrolled. Patients were assigned to receive (ABVD) for four cycles followed by randomization for radiotherapy into two arms one arm of 30 Gy INRT +/ 6 Gy to residual disease or another arm of 30 Gy IFRT +/ 6 Gy to residual disease. Results: 35 patients were enrolled in this study: 16 patients in the INRT arm and 19 patients in the IFRT arm. The median observation time was 25 months. The overall survival for all eligible patients was 97% and freedom from treatment failure was 85.7%. Survival rates at the end of the study revealed no differences between INRT and IFRT arms. Also, in terms of complete remission post radiotherapy (14 versus 15), relapse (1 versus 4), and death (0 versus 1) respectively the outcome was similar in both arms. As regard acute and sub-acute toxicities no significant difference could be detected between both arms except that IFRT arm was associated with a higher incidence of radiation pneumonitis (4 versus 1 patient). Conclusion: Radiotherapy volume size reduction from IFRT to INRT after ABVD chemotherapy for four cycles produces similar results and less toxicity in patients with early-stage Hodgkin’s lymphoma especially in patients with mediastinal disease.

Share and Cite:

H. Zwam, E. Habib and M. AL-Daly, "Involved Nodal Radiotherapy vs. Involved Field Radiotherapy after Chemotherapy in the Treatment of Early Stage Hodgkin’s Lymphoma," Journal of Cancer Therapy, Vol. 4 No. 1, 2013, pp. 271-279. doi: 10.4236/jct.2013.41034.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. Jemal, R. Siegel, E. Ward, et al., “Cancer Statistics,” CA: A Cancer Journal for Clinicians, Vol. 56, No. 2, 2006, pp. 106-130. doi:10.3322/canjclin.56.2.106
[2] R. T. Hoppe, R. H. Advani, P. J. Bierman, et al., “Hodgkin Lymphoma: Clinical Practice Guidelines in Oncology,” Journal of the National Comprehensive Cancer Network, Vol. 4, No. 3, 2006, pp. 210-230.
[3] G. Bonadonna, V. Bonfante, S. Viviani, et al., “ABVD plus Subtotal Nodal versus Involved-Field Radiotherapy in Early-Stage Hodgkin’s Disease: Long-Term Results,” Journal of Clinical Oncology, Vol. 22, No. 14, 2004, pp. 2835-2841. doi:10.1200/JCO.2004.12.170
[4] K. Ng, “Late Complications after Treatment for Hodgkin Lymphoma,” Current Hematologic Malignancy Reports, Vol. 3, No. 3, 2008, pp. 119-125. doi:10.1007/s11899-008-0018-6
[5] K. Ng, M. P. Bernardo, E. Weller, et al., “Long-Term Survival and Competing Causes of Death in Patients with Early-Stage Hodgkin’s Disease Treated at Age 50 or Younger,” Journal of Clinical Oncology, Vol. 20, No. 8, 2002, pp. 2101-2108. doi:10.1200/JCO.2002.08.021
[6] P. Mauch, “Second Malignancies after Curative Radiation Therapy for Good Prognosis Cancers,” International Journal of Radiation Oncology, Biology, Physics, Vol. 33, No. 4, 1995, pp. 959-960. doi:10.1016/0360-3016(95)02141-9
[7] A. Engert, P. Schiller, A. Josting, et al., “Involved-Field Radiotherapy is Equally Effective and Less Toxic Compared with Extended-Field Radiotherapy after Four Cycles of Chemotherapy in Patients with Early-Stage Unfavourable Hodgkin’s Lymphoma: Results of the HD8 Trial of the German HL Study Group,” Journal of Clinical Oncology, Vol. 21, No. 19, 2003, pp. 3601-3608. doi:10.1200/JCO.2003.03.023
[8] V. B. Ad, O. Paltiel and E. Glatstein, “Radiotherapy for Early-Stage Hodgkin’s Lymphoma: A 21st Century Perspective and Review of Multiple Randomized Clinical Trials,” International Journal of Radiation Oncology, Biology, Physics, Vol. 72, No. 5, 2008, pp. 1472-9. doi:10.1016/j.ijrobp.2008.08.026
[9] A. Gallamini, et al., “Early Interim PET Scan in Hodgkin Lymphoma: Where Do We Stand?” Leukemia & Lymphoma, Vol. 49, No. 4, 2008, pp. 659-62. doi:10.1080/10428190801888704
[10] T. Kazama, F. S. Varavithya V, Phongkitkarun S, Ito H, “Macapinlac HA: FDG PET in the Evaluation of Treatment for Lymphoma: Clinical Usefulness and Pitfalls,” Radiographics, Vol. 25, No. 1, 2005, pp. 191-207. doi:10.1148/rg.251045045
[11] E. M. Noordijk, J. Thomas, C. Ferme, et al., “First Results of the EORTC-GELA Randomized Trials: The H9-F Trial (Comparing 3 Radiation Dose Levels) and the H9-U Trial (Comparing 3 Chemotherapy Schemes) in Patients with Favorable or Unfavorable Early Stage HL,” Journal of Clinical Oncology, Vol. 23, No. 16S, 2005, p. 6505.
[12] J. M. P. Yahalom, “The Involved Feild is Back: Issues in deleniating thr readiation feild in HL,” Annals of Oncology, Vol. 13, Suppl. 1, 2002, pp. 79-83.
[13] V. Diehl, C. Brillant, A. Engert, et al., “HD10: Investigating Reduction of Combined Modality Treatment Intensity in Early Stage Hodgkin’s Lymphoma. Interim Analysis of a Randomized Trial of the German Hodgkin Study Group (GHSG),” Journal of Clinical Oncology, Vol. 23, No. 2005, pp. 16S-5561.
[14] T. Girinsky and M. Ghalibafian, “Radiotherapy of Hodgkin Lymphoma: Indications, New Fields, and Techniques,” Seminars in Radiation Oncology, Vol. 17, No. 3, 2007, pp. 206-222. doi:10.1016/j.semradonc.2007.02.007
[15] H. T. Eich, et al., “Involved-Node Radiotherapy in Early-Stage Hodgkin’s Lymphoma. Definition and Guidelines of the German Hodgkin Study Group (GHSG),” Strahlentherapie und Onkologie, Vol. 184, No. 8, 2008, pp. 406-410. doi:10.1007/s00066-008-1882-7
[16] L. G. R. Specht, M. J. Clarke, et al., “Influence of More Extensive Radiotherapy and Adjuvant Chemotherapy on Long-Term Outcome of Early-Stage Hodgkin’s Disease: A Meta-Analysis of 23 Randomized Trials Involving 3888 Patients,” Journal of Clinical Oncology, Vol. 16, No. 3, 1998, pp. 830-843.
[17] O. W. Press, M. LeBlanc, A. S. Lichter, et al., “Phase III Randomized Intergroup Trial of Subtotal Lymphoid Irradiation Versus Doxorubicin, Vinblastine, and Subtotal Lymphoid Irradiation for Stage IA to IIA Hodgkin’s Disease,” Journal of Clinical Oncology, Vol. 19, No. 22, 2001, pp. 4238-4244.
[18] M. Shahidi, et al., “Site of Relapse after Chemotherapy Alone for Stage I and II Hodgkin’s Disease,” Radiotherapy & Oncology, Vol. 78, No. 1, 2006, pp. 1-5. doi:10.1016/j.radonc.2005.10.018
[19] J. Yahalom, “Don’t Throw out the Baby with the Bathwater: On Optimizing Cure and Reducing Toxicity in Hodgkin’s Lymphoma,” Journal of Clinical Oncology, Vol. 24, No. 4, 2006, pp. 544-548. doi:10.1200/JCO.2005.04.4396
[20] G. P. Canellos, “Chemotherapy Alone for Early Hodgkin’s Lymphoma: An Emerging Option,” Journal of Clinical Oncology, Vol. 23, No. 21, 2005, pp. 4574-4576. doi:10.1200/JCO.2005.01.911
[21] H. Eghbali, P. Brice, G. Creemers, et al., “Comparison of Three Radiation Dose Levels after EBVP Regimen in Favorable Supra-Diaphragmatic Clinical Stages (CS) I-II Hodgkin’s Lymphoma (HL): Preliminary Results of the EORTC-GELA H9-F Trial,” Blood, Vol. 106, No. 11, 2005, p. 814.
[22] B. A. Campbell, N. Voss, T. Pickles, et al., “Involved-Nodal Radiation Therapy as a Component of Combination Therapy for Limited-Stage Hodgkin’s Lymphoma: A Question of Field Size,” Journal of Clinical Oncology, Vol. 26, No. 32, 2008, pp. 5170-5174. doi:10.1200/JCO.2007.15.1001
[23] A. M. Fox, A. P. Dosoretz, P. M. Mauch, Y. H. Chen, D. C. Fisher, A. S. LaCasce, A. S. Freedman, B. Silver and A. K. Ng, “Predictive Factors for Radiation Pneumonitis in Hodgkin Lymphoma Patients Receiving Combined-Modality Therapy,” International Journal of Radiation Oncology, Biology, Physics, Vol. 83, No. 1, 2012, pp. 277-283.
[24] B. M. Aleman, A. W. van den Belt-Dusebout, W. J. Klokman, et al., “Long-Term Cause Specific Mortality of Patients Treated for Hodgkin’s Disease,” Journal of Clinical Oncology, Vol. 21, No. 18, 2003, pp. 3431-3439. doi:10.1200/JCO.2003.07.131
[25] J. Franklin, A. Pluetschow, M. Paus, et al., “Second Malignancy Risk Associated with Treatment of Hodgkin’s Lymphoma: Meta-Analysis of the Randomised Trials,” Annals of Oncology, Vol. 17, No. 12, 2006, pp. 1749-1760. doi:10.1093/annonc/mdl302
[26] E.-S. Koh, T. H Tran, M. Heydarian, et al., “A Comparison of Mantle versus Involved Field Radiotherapy for Hodgkin’s Lymphoma: Reduction in Normal Tissue Dose and Second Cancer Risk,” Radiation Oncology, Vol. 2, No. 3, 2007, p. 13. doi:10.1186/1748-717X-2-13
[27] J. Koeck, Y. Abo-Madyan, F. Lohr, F. Stieler, J. Kriz, R. P. Mueller, F. Wenz and H. T. Eich, “Radiotherapy for Early Mediastinal Hodgkin Lymphoma According to the German Hodgkin Study Group (GHSG): The Roles of Intensity-Modulated Radiotherapy and Involved-Node Radiotherapy,” International Journal of Radiation Oncology, Biology, Physics, Vol. 83, No. 1, 2012, pp. 268-276.
[28] D. C. Weber, et al., “Involved-Node and Involved-Field Volumetric Modulated Arc vs. Fixed Beam Intensity-Modulated Radiotherapy for Female Patients with Early-Stage Supra-Diaphragmatic Hodgkin Lymphoma: A Comparative Planning Study,” International Journal of Radiation Oncology, Biology, Physics, Vol. 75, No. 5, 2009. pp. 1578-1586. doi:10.1016/j.ijrobp.2009.05.012
[29] B. A. Campbell, et al., “Minimising Critical Organ Irradiation in Limited Stage Hodgkin Lymphoma: A Dosimetric Study of the Benefit of Involved Node Radiotherapy,” Annals of Oncology, Vol. 23, No. 5, 2012, pp. 1259-1266. doi:10.1093/annonc/mdr439

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.