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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.
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.
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.
The interim scan should be used to intensify treatment in early Hodgkin lymphoma, not to withhold radiotherapy. The 99.0 per cent five-year progression-free survival in the scan-negative favourable group with combined-modality treatment is the number any radiotherapy-sparing strategy has to match.
The reason every current Hodgkin lymphoma trial is a de-escalation trial, and the reason survivors need lifelong surveillance rather than discharge at five years. It is also a warning about assuming that a gentler protocol is a safer one until a cohort has been followed long enough to say.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, GHSG HD16, EORTC/LYSA/FIL H10, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens) and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, GHSG HD16, RADAR, Early-stage classical Hodgkin lymphoma (stage I to II) and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Brentuximab vedotin, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy, Survivorship and late effects are neglected and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Bleomycin, Survivorship and late effects are neglected and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Bleomycin, Survivorship and late effects are neglected and the tag lymphoma-evidence.