Field and Nodal Irradiation in Early Stage Hodgkin’s Lymphoma: A Single Institution Study

Background: With the introduction of Hodgkin lymphoma patients receiving 
combined modality therapy, extended field radiation techniques were replaced 
by involved field radiotherapy (IFRT). Recent research has demonstrated the 
safety of further field site reductions. By using the idea of involved node 
radiotherapy (INRT), the risk of radiation-induced toxicity can be decreased 
without compromising the effectiveness of treatment. The foundation of INRT 
is treating only the lymph nodes that were initially involved and omitting any 
adjacent uninvolved nodal areas. 
Patients and methods: 66 patients with early-stage Hodgkin's lymphoma were 
collected within the previous five years in SECI and were classified into two 
arms either IFRT or INRT after receiving chemotherapy according to disease 
stage. Out of those patients thirty eight received (IF) and twenty eight received 
(IN). Radiotherapy dose used for all patients was 20- 30 Gy. Patients were 
assessed for treatment toxicity and local recurrence. 
Results: Median follow up time of all patients was about 40 months. It was 
found that involved INRT was not inferior to IFRT. No difference in efficacy 
between both arms and also with comparable toxicity. Both groups had 
comparable characteristics, laboratory data, and response to chemotherapy. 
Relapse occurred in four patients (10.5%) in IFRT group and two patients 
(7.1%) in INRT group. Also, both groups had insignificant difference as regard 
overall survival 56.78 ± 2.40 vs. 56.78 ± 2.19 (months), of (IF) and (IN) 
respectively with p- value of 0.30. Both groups had comparable early toxicity 
and its grades, response and late toxicity (p> 0.05). Late complications as 
hypothyroidism developed in three patients of IFRT group and two patients of 
INRT group. Pulmonary fibrosis developed only in four (10.5%) patients of 
IFRT group. 
Conclusion: The main finding in this study is that (IN) is not inferior to (IF) as 
regards efficacy and at least same toxicity therefore (IN) radiotherapy can 
replace (IF).