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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.
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.
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.
Shares GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma, Andreas Engert, Peter Borchmann, German Hodgkin Study Group and the tag lymphoma-evidence.
Shares GHSG HD16, A radiotherapy-free cure for early Hodgkin lymphoma that actually holds, Deauville five-point scale, RADAR and the tag lymphoma-evidence.
Shares GHSG HD16, A radiotherapy-free cure for early Hodgkin lymphoma that actually holds, Deauville five-point scale, RADAR and the tag lymphoma-evidence.
Shares Andreas Engert, Peter Borchmann, German Hodgkin Study Group, Deauville five-point scale and the tag lymphoma-evidence.
Shares Andreas Engert, Peter Borchmann, German Hodgkin Study Group, Deauville five-point scale 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.