# RAPID: PET-directed therapy for early-stage Hodgkin lymphoma

Source: https://onco.cc/key-papers/paper-rapid-pet-directed-therapy-early-hodgkin-nejm-2015/  
OnCo record `paper-rapid-pet-directed-therapy-early-hodgkin-nejm-2015` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients with early Hodgkin lymphoma whose PET scan was clear after three cycles of ABVD did almost as well without radiotherapy as with it, with a small extra risk of relapse but no difference in survival, giving them a choice.

## Summary

UK randomised non-inferiority trial of 602 patients with stage IA or IIA non-bulky Hodgkin lymphoma; those with a negative PET after three cycles of ABVD (420 patients) were randomised to involved-field radiotherapy of 30 Gy or no further treatment.

Three-year progression-free survival was 94.6 percent with radiotherapy against 90.8 percent without, which did not meet the pre-specified non-inferiority margin in the intention-to-treat analysis, while overall survival was the same. Omitting radiotherapy trades a few percentage points of relapse for avoiding late radiation effects.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: New England Journal of Medicine
- Year: 2015
- DOI: 10.1056/NEJMoa1408648
- Authors: Radford J, Illidge T, Counsell N, et al.
- Findings: Three-year progression-free survival 94.6 percent with radiotherapy versus 90.8 percent without in PET-negative patients.; No difference in overall survival; non-inferiority was not formally shown.
- What it means: PET-negative early Hodgkin lymphoma can be treated with chemotherapy alone at a small cost in relapse, an option many younger patients take to avoid radiation to the chest and neck.
- Caveats: Relapses after chemotherapy alone are usually salvaged, but require more intensive treatment.; The trial used ABVD alone; the balance may differ with newer regimens.

## Sources

- N Engl J Med 2015: https://doi.org/10.1056/NEJMoa1408648
- PubMed: https://pubmed.ncbi.nlm.nih.gov/25901426/

## Connected records

- cancers: [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/)
- drugs: [Dacarbazine](https://onco.cc/drugs/dacarbazine/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Vinblastine](https://onco.cc/drugs/vinblastine/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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