{"entity":{"id":"paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019","kind":"paper","name":"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","aka":["HD16","Fuchs 2019"],"tldr":"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.\n\nAmong 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.","asOf":"2026-10-01","links":[{"label":"Journal of Clinical Oncology 2019","url":"https://doi.org/10.1200/JCO.19.00964"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/31498753/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/31498753"}],"tags":["lymphoma-evidence"],"related":["paper-schaapveld-second-cancer-risk-40-years-hodgkin-nejm-2015","lymphoma-roadmap"],"cancers":["early-stage-classical-hodgkin-lymphoma","hodgkin-lymphoma"],"sections":["radiation","imaging"],"technologies":["radiotherapy","pet-ct"],"targets":[],"drugs":["doxorubicin","bleomycin","vinblastine","dacarbazine"],"companies":["ghsg"],"institutions":[],"pathways":[],"terms":["deauville-score","abvd-beacopp"],"trials":["hd16","radar-hodgkin"],"people":["peter-borchmann","andreas-engert"],"bottlenecks":["b-negative-results","b-survivorship"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2019,"doi":"10.1200/JCO.19.00964","pmid":"31498753","authors":"Fuchs M, Goergen H, Kobe C, et al.","paperType":"rct","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)."],"whatItMeans":"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."],"changedPractice":true,"participants":1150},"route":"/key-papers/paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019/","neighbours":{"paper":[{"id":"paper-ghsg-hd10-reduced-intensity-early-hodgkin-nejm-2010","kind":"paper","name":"GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma","route":"/key-papers/paper-ghsg-hd10-reduced-intensity-early-hodgkin-nejm-2010/"},{"id":"paper-schaapveld-second-cancer-risk-40-years-hodgkin-nejm-2015","kind":"paper","name":"Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma","route":"/key-papers/paper-schaapveld-second-cancer-risk-40-years-hodgkin-nejm-2015/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/lymphoma-roadmap/"}],"cancer":[{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"section":[{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"},{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"term":[{"id":"abvd-beacopp","kind":"term","name":"ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)","route":"/terms/abvd-beacopp/"},{"id":"deauville-score","kind":"term","name":"Deauville five-point scale","route":"/terms/deauville-score/"},{"id":"radiotherapy","kind":"term","name":"Radiotherapy","route":"/terms/radiotherapy/"}],"technology":[{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"dacarbazine","kind":"drug","name":"Dacarbazine","route":"/drugs/dacarbazine/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"vinblastine","kind":"drug","name":"Vinblastine","route":"/drugs/vinblastine/"}],"company":[{"id":"ghsg","kind":"company","name":"German Hodgkin Study Group","route":"/companies/ghsg/"}],"trial":[{"id":"hd16","kind":"trial","name":"GHSG HD16","route":"/trials/hd16/"},{"id":"radar-hodgkin","kind":"trial","name":"RADAR","route":"/trials/radar-hodgkin/"}],"person":[{"id":"andreas-engert","kind":"person","name":"Andreas Engert","route":"/people/andreas-engert/"},{"id":"peter-borchmann","kind":"person","name":"Peter Borchmann","route":"/people/peter-borchmann/"}],"bottleneck":[{"id":"b-negative-results","kind":"bottleneck","name":"Failures are hidden","route":"/bottlenecks/b-negative-results/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}],"idea":[{"id":"lymphoma-ev-radiotherapy-free-early-hodgkin","kind":"idea","name":"A radiotherapy-free cure for early Hodgkin lymphoma that actually holds","route":"/ideas/lymphoma-ev-radiotherapy-free-early-hodgkin/"},{"id":"lymphoma-ev-ctdna-instead-of-the-interim-scan","kind":"idea","name":"Use circulating tumour DNA instead of the interim scan to decide what happens next","route":"/ideas/lymphoma-ev-ctdna-instead-of-the-interim-scan/"}]}}