ASTRO: Radiation Therapy Improves Survival in Patients With Early-Stage Hodgkin Lymphoma
Patients with stage I and II Hodgkin lymphoma who received consolidated radiation experienced improved 10-year survival rates, according to research presented at the American Society for Radiation Oncology (ASTRO) 56th Annual Meeting (Abstract CT-08). The 10-year survival rate for patients who received radiation therapy was 84% vs 76% for those who did not receive radiation therapy. Despite these findings, the data also showed that the use of radiation therapy has decreased significantly since 1998.
Study Details
Researchers evaluated clinical features and survival outcomes among 41,502 patients diagnosed with stage I and II Hodgkin lymphoma from 1998 to 2011 from a prospectively collected database, the National Cancer Data Base (NCDB), which is comprised of cases from 1,500 sites and represents > 75% of all cancers diagnosed in the United States. The average patient age was 37 (range, 18–90), with a median follow-up of 7.5 years. The association between radiation therapy use, covariables, and outcome were assessed in a multivariate Cox proportional hazards model. Survival was estimated using the Kaplan-Meier method.
Multi-agent chemotherapy was administered to 96% (39,842) of the patients, and 49% (20,441) of patients received a median radiation dose of 30.6 Gy. The 10-year overall survival of the entire group was 80.8%, with patients receiving radiation having a statistically significant improved overall survival rate at 10 years, when compared to those not receiving radiation (84.4% vs 76.4%, P < .00001). Additionally, the omission of radiation therapy was related to higher rates of salvage transplant procedures performed.
Despite this benefit, the utilization of radiation therapy for patients with early-stage Hodgkin lymphoma decreased at the study sites from 56% to 41% between 1998 and 2011; and in 88.4% of the patients, the physician-reported reason given for not administering radiation therapy was that it was not part of the planned initial treatment strategy. The research also indicated that use of radiation therapy was associated with younger patients (≤ 40 years), who are in a higher socioeconomic status, who had access to health insurance, and who received treatment at comprehensive cancer centers (all P < .0001).
Barriers to Care
“Multiple prospective, randomized trials have shown a significant improvement in disease control with the addition of radiation therapy, however previous trials were limited by low patient numbers and limited follow-up and thus, were unable to demonstrate an overall survival benefit,” said lead study author Rahul R. Parikh, MD, a radiation oncologist at Mount Sinai Beth Israel and an Assistant Professor of Radiation Oncology at Icahn School of Medicine at Mount Sinai.
“This is the largest dataset in this patient population to demonstrate a survival benefit with the addition of radiation therapy. Given that the utilization of radiation therapy was associated with younger age, insurance status, higher socioeconomic status, and treatment at comprehensive cancer centers, we have highlighted ongoing disparities in Hodgkin lymphoma treatment and it is important that we recognize these findings as potential barriers to care. Given the survival benefit demonstrated in this study, radiotherapy should be included in the combined modality approach of multi-agent chemotherapy followed by consolidation radiation therapy in order to maintain high overall survival rates for this curable disease,” he said.
The study authors reported no potential conflicts of interest.
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