Radiation Dose Reduction in Early Stage Hodgkin Lymphoma

Abstract Introduction Treatment for early-stage Hodgkin lymphoma (HL) involves radiation therapy (RT), chemotherapy or combined modality therapy (CMT). We analyzed reduction of RT dose in CMT, particularly in the context of GHSG HD10 randomized trial results. Materials/Methods The National Cancer Database was queried for stage I-II HL patients receiving CMT. RT dose and associated characteristics were analyzed. Stage I and absence of B symptoms was used as a surrogate for early-stage favorable disease. Results Of 31,301 patients with stage I-II HL, 11,457 received CMT between 2004-2015. Using the surrogate defined above, 1955 patients (17.1%) were classified as favorable. The majority (61.6%) received 30-36Gy while 7.0% received 20Gy. The use of 20Gy was more common in stage I patients (12.3% vs. 5.4% in stage II) and academic facilities (10.8% vs. 6.3-8.9% at other facilities). Use of 20Gy (vs. 30-36Gy) was less likely with thorax site (OR 0.43 vs. HN), stage II disease (OR 0.41), and B symptoms (OR 0.33). Notably, the use of 20Gy increased dramatically after 2010 (year of HD10 publication), with rates of 12.3% in 2010-2015 vs. 2.1% in 2004-2009 (OR 6.3, p 36Gy is decreasing over a corresponding time period (OR 0.44, p Conclusions Analysis of CMT for patients with early-stage HL demonstrates variability in RT dose, including increasing use of 20Gy and decreasing use of high doses >36Gy.