Consolidation radiotherapy for Early-Stage Hodgkin’s Lymphoma either with involved node radiotherapy or involved field radiotherapy.

Background: Radiation therapy still plays an important role in the treatment of patients with Hodgkin’s lymphoma. The goal of treatment of early-stage, stage I or II, Hodgkin’s lymphoma is to cure the disease together with minimizing the short and long-term complications. Complications related to radiation therapy depends on the radiation dose and the irradiated field size. Over the past four decades, the very large extended field RT had been replaced with the involved field RT using technological developments in imaging, treatment planning, and treatment machines. This allowed very significant reduction in radiation doses to normal tissues without reducing the coverage of the affected nodes. Our study is to evaluate the possibility of much reducing the radiation field size from involved field RT to involved node RT without affecting the efficacy of treatment.
Methods: All newly diagnosed early-stage supradiaphragmatic Hodgkin’s lymphoma patients attending south Egypt cancer institute were enrolled into this study after receiving 2 – 4 cycles of ABVD and after a written consent. Patients were randomized to receive consolidation radiotherapy using either IFRT or INRT technique. Radiotherapy dose used for all patients was 20- 30 Gy. Patients were assessed for treatment toxicity and local recurrence.
Results: 49 patients were enrolled in our study: 19 patients in the INRT arm and 30 patients in the IFRT arm. The median follow-up was 14 months. The overall survival for all patients was 98% and freedom from treatment failure was 89.8% with no difference in survival rates between both arms. Also, post radiotherapy complete remission was 9(47.4%) versus 12(40%), relapse 2 (10.5%) versus 3 (10%), and death (0 versus 1) respectively the outcome was similar in both arms. Regarding acute and sub-acute toxicities no significant difference could be detected between both arms except that IFRT arm was associated with a higher incidence of radiation pneumonitis (4 versus 1 patient).
Conclusion: reducing the irradiated field size in treatment of early-stage Hodgkin’s lymphoma from involved field RT to involved node RT can be used without affecting the efficacy of treatment and with less treatment toxicity.