# A radiotherapy-free cure for early Hodgkin lymphoma that actually holds

Source: https://onco.cc/ideas/lymphoma-ev-radiotherapy-free-early-hodgkin/  
OnCo record `lymphoma-ev-radiotherapy-free-early-hodgkin` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Every attempt to drop radiotherapy from early Hodgkin lymphoma on the strength of a clear scan has cost people their remission. Changing the chemotherapy as well is the next attempt.

## Summary

There is a second-order problem the trials cannot settle quickly. The late-effect figures that justify omitting radiotherapy come from patients treated with mantle fields up to 2000; modern involved-site radiotherapy delivers a fraction of that dose to a fraction of the volume, and nobody knows what its 40-year risk is. The de-escalation may be chasing a harm that has already shrunk, which is an argument for building the survivorship cohorts rather than against running the trial.

## Fields

- Kind: Idea
- Last checked: 2026-10-01
- Also known as: Omitting radiotherapy in early-stage Hodgkin lymphoma; Radiotherapy-free early Hodgkin lymphoma
- Tags: lymphoma-evidence
- Hypothesis: Replacing bleomycin with brentuximab vedotin in early-stage Hodgkin lymphoma makes it possible to omit radiotherapy entirely in patients with a Deauville score of 1 to 3 after two cycles, without the loss of tumour control that HD16 and EORTC H10 recorded.
- Rationale: The reason to want this is measured: 48.5 per cent of Hodgkin lymphoma survivors developed a second cancer within 40 years in the Dutch cohort, 50 per cent developed cardiovascular disease, and breast cancer risk rose eightfold above 40 Gy to the breast with no plateau. The reason it has not worked is also measured: HD16 lost 7.3 percentage points of five-year progression-free survival when radiotherapy was omitted after a negative scan, and EORTC H10 could not demonstrate non-inferiority in either risk group, with 99.0 against 87.1 per cent in the favourable group. Both trials kept ABVD and changed only the radiotherapy. RADAR changes the chemotherapy too.
- Proposed test: RADAR (NCT04685616) is the test: 1,042 patients randomised between ABVD and A2VD with radiotherapy given only for a Deauville score of 4, primary completion listed for September 2030. A positive result needs progression-free survival in the radiotherapy-free group to match the 93 to 99 per cent combined-modality benchmark, not merely to be non-inferior against a wide margin.
- Maturity: being-tested-at-scale
- Actor: research

## Connected records

- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- ideas: [Chemotherapy-free Hodgkin lymphoma: brentuximab + PD-1 in early stage](https://onco.cc/ideas/idea-chemo-free-hodgkin/)
- cancers: [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- fronts: [Antibody-Drug Conjugates](https://onco.cc/fronts/adcs/), [Radiation Therapy](https://onco.cc/fronts/radiation/)
- terms: [ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)](https://onco.cc/terms/abvd-beacopp/), [Deauville five-point scale](https://onco.cc/terms/deauville-score/), [Radiotherapy](https://onco.cc/terms/radiotherapy/)
- technologies: [Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/), [PET/CT](https://onco.cc/technologies/pet-ct/)
- targets: [CD30](https://onco.cc/targets/cd30/)
- drugs: [Bleomycin](https://onco.cc/drugs/bleomycin/), [Brentuximab vedotin](https://onco.cc/drugs/brentuximab-vedotin/), [Dacarbazine](https://onco.cc/drugs/dacarbazine/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Vinblastine](https://onco.cc/drugs/vinblastine/)
- trials: [EORTC/LYSA/FIL H10](https://onco.cc/trials/eortc-h10/), [GHSG HD16](https://onco.cc/trials/hd16/), [RADAR](https://onco.cc/trials/radar-hodgkin/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial](https://onco.cc/key-papers/paper-eortc-h10-pet-adapted-early-hodgkin-jco-2017/), [Positron emission tomography-guided treatment in early-stage favorable Hodgkin lymphoma: final results of the international, randomized phase III HD16 trial by the German Hodgkin Study Group](https://onco.cc/key-papers/paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019/), [Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma](https://onco.cc/key-papers/paper-schaapveld-second-cancer-risk-40-years-hodgkin-nejm-2015/)

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