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Radiotherapy shows potential role in treatment of Hodgkin lymphoma subtype

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November 17, 2017

David K. Gaffney

Radiotherapy prolonged OS among patients with all stages of nodular lymphocytic Hodgkin lymphoma, including those with B-symptoms, according to study results.

However, patients with advanced-stage disease and B-symptoms appeared unlikely to undergo radiotherapy, results also showed.

“Treatment of nodular lymphocytic Hodgkin lymphoma is controversial,” David K. Gaffney, MD, PhD, vice-chair and professor of radiation oncology and senior director for clinical research at Huntsman Cancer Institute of The University of Utah, and colleagues wrote. “Owing to the rare nature of nodular lymphocytic Hodgkin lymphoma, treatment guidelines are based on conclusions derived from limited retrospective studies.”

Radiotherapy has demonstrated improved PFS for patients with early-stage nodular lymphocytic Hodgkin lymphoma, but its use for patients with advanced-stage disease is less clear.

Gaffney and colleagues used the National Cancer Data Base to examine the role of radiotherapy for treating all stages of nodular lymphocytic Hodgkin lymphoma.

The analysis included data from 1,968 patients (median age, 46 years; 69.3% white). Stage I served as the predominant stage at presentation (40.6%), and 83.6% of patients lacked B-symptoms.

Compared with patients with stage I disease, radiotherapy receipt appeared less common among those with stage II disease (OR = 0.74; P = .02), stage III disease (OR = 0.03; P < .01) and stage IV disease (OR = 0.11; P < .01).

Radiotherapy receipt also was less common among older patients (OR = 0.83; P = .01), those with B-symptoms (OR = 0.62; P = .01), those with Medicare (OR = 0.67; P = .04), black patients (OR = 0.67; P = .01), those who received chemotherapy (OR = 0.34; P .01), and those with a Charlson comorbidity score of 1(OR = 0.61; P = .02).

Regardless of disease stage, radiotherapy receipt appeared associated with longer survival (50.1 months vs. 42.4 months; P < .01).

This finding persisted when researchers evaluated patients with early-stage disease (49.8 months vs. 45.5 months; P < .01) and B-symptoms (49 months vs. 42.6 months; P < .01), with a trend toward improved survival observed among patients with advanced-stage disease (54.1 months vs. 39.6 months).

Multivariate analyses showed radiotherapy receipt reduced the risk for death (HR = 0.37; 95% CI, 0.23-0.6) among all patients.

Researchers noted that because the study was retrospective, confounders and selection bias may limit these findings.

However, it is the largest retrospective study to evaluate the role of radiation across stages of nodular lymphocytic Hodgkin lymphoma.

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“Currently, among patients with nodular lymphocytic Hodgkin lymphoma with advanced-stage disease or early-stage disease with B-symptoms, radiotherapy is not predominantly utilized as a definitive or adjunct treatment,” Gaffney and colleagues wrote. “Our preliminary study suggests that there might be a role for radiotherapy in such settings.” – by Alexandra Todak

 

Disclosures: The authors report no relevant financial disclosures.

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