# 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

Source: https://onco.cc/key-papers/paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019/  
OnCo record `paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Trying to spare radiotherapy on the strength of a clear scan after two rounds of chemotherapy cost about seven people in a hundred their remission.

## Summary

An international randomised phase 3 trial recruiting patients aged 18 to 75 with newly diagnosed early-stage favourable Hodgkin lymphoma between November 2009 and December 2015. Patients were assigned to standard combined-modality treatment of two cycles of ABVD with 20 Gy of involved-field radiotherapy, or to positron emission tomography-guided treatment omitting the radiotherapy after a negative scan following two cycles. 1,150 patients were enrolled and median follow-up was 45 months.

Among 628 scan-negative patients treated per protocol, five-year progression-free survival was 93.4 per cent (95 per cent confidence interval 90.4 to 96.5) with combined-modality treatment and 86.1 per cent (81.4 to 90.9) with ABVD alone, a difference of 7.3 percentage points (1.6 to 13.0) and a hazard ratio of 1.78 (1.02 to 3.12). Five-year overall survival was 98.1 per cent (96.5 to 99.8) and 98.4 per cent (96.5 to 100.0). Among 693 patients assigned to combined-modality treatment, five-year progression-free survival was 93.2 per cent in scan-negative patients against 88.4 per cent in scan-positive patients (p = 0.047), and 93.1 against 80.9 per cent (p = 0.0011) when a Deauville score of 4 was used as the threshold for positivity.

## Fields

- Kind: Key paper
- Last checked: 2026-10-01
- Also known as: HD16; Fuchs 2019
- Tags: lymphoma-evidence
- Journal: Journal of Clinical Oncology
- Year: 2019
- DOI: 10.1200/JCO.19.00964
- Authors: Fuchs M, Goergen H, Kobe C, et al.
- Findings: Among 628 scan-negative patients, five-year progression-free survival was 93.4 per cent with combined-modality treatment and 86.1 per cent with ABVD alone (difference 7.3 percentage points, hazard ratio 1.78, 95 per cent confidence interval 1.02 to 3.12).; Five-year overall survival was 98.1 per cent with combined-modality treatment and 98.4 per cent with ABVD alone.; A positive scan after two cycles predicted worse five-year progression-free survival within the combined-modality arm, 88.4 against 93.2 per cent (p = 0.047).; Using a Deauville score of 4 as the threshold for positivity widened the difference to 80.9 against 93.1 per cent (p = 0.0011).
- What it means: Radiotherapy cannot be omitted in early-stage favourable Hodgkin lymphoma on the basis of a negative interim scan without a clinically relevant loss of tumour control. The scan is better at identifying who needs more than at identifying who needs less.
- Caveats: Median follow-up of 45 months is short relative to the late effects that make omitting radiotherapy desirable; the survival curves are identical so far.; The per-protocol analysis of scan-negative patients is not the intention-to-treat population.; 20 Gy involved-field radiotherapy is a far smaller exposure than the mantle fields that produced the late-effect figures in the Dutch cohorts, so the trade-off being weighed is not the historical one.

## Sources

- Journal of Clinical Oncology 2019: https://doi.org/10.1200/JCO.19.00964
- PubMed: https://pubmed.ncbi.nlm.nih.gov/31498753/
- Europe PMC: https://europepmc.org/article/MED/31498753

## Connected records

- key papers: [GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma](https://onco.cc/key-papers/paper-ghsg-hd10-reduced-intensity-early-hodgkin-nejm-2010/), [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/)
- 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/)
- 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/)
- fronts: [Imaging](https://onco.cc/fronts/imaging/), [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: [PET/CT](https://onco.cc/technologies/pet-ct/)
- drugs: [Bleomycin](https://onco.cc/drugs/bleomycin/), [Dacarbazine](https://onco.cc/drugs/dacarbazine/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Vinblastine](https://onco.cc/drugs/vinblastine/)
- companies: [German Hodgkin Study Group](https://onco.cc/companies/ghsg/)
- trials: [GHSG HD16](https://onco.cc/trials/hd16/), [RADAR](https://onco.cc/trials/radar-hodgkin/)
- people: [Andreas Engert](https://onco.cc/people/andreas-engert/), [Peter Borchmann](https://onco.cc/people/peter-borchmann/)
- bottlenecks: [Failures are hidden](https://onco.cc/bottlenecks/b-negative-results/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- ideas: [A radiotherapy-free cure for early Hodgkin lymphoma that actually holds](https://onco.cc/ideas/lymphoma-ev-radiotherapy-free-early-hodgkin/), [Use circulating tumour DNA instead of the interim scan to decide what happens next](https://onco.cc/ideas/lymphoma-ev-ctdna-instead-of-the-interim-scan/)

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