Consolidative Radiotherapy

The advantages of using RT in the post-ASCT setting include converting a CT-determined partial response to a complete response and reducing the size of the radiation field in patients with bulky disease by highdose chemotherapy. It does not have the drawback of delaying the administration of high-dose chemotherapy or of overlapping pneumonitis, which can be seen with the combination of RT and carmustine-based HDT.36-40 Consolidative RT may, however, produce significant myelosuppression. This has largely been avoided by waiting for proper hematologic recovery and initiating RT within 3 months of ASCT. However, due to this selection bias, patients with early disease progression post-ASCT will not be eligible to receive consolidative RT with curative intent.

One of the earlier studies by Jagannath et al. at MD Anderson Cancer Center involved treatment of 61 patients with HDT/ASCT. Of 18 patients achieving a partial response, six were converted to a CR with local RT.41 Subsequently, Mundt et al. reported the experience at the University of Chicago with IFRT in 54 patients with relapsed/refractory HL. Forty-six percent of patients relapsed, two-thirds at sites of prior nodal

Table 7S.:

Role of involved field radiotherapy as part of management in relapsed/refractory HL

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