Radiation therapy alone

Staging laparotomy was part of the standard work up of patients with HL in the 1960s and 1970s, in part due to a lack of effective radiological techniques to evaluate abdominal and pelvic lymphadenopathy. Most patients therefore underwent pathologic staging. In contrast, at the present time few patients undergo pathologic staging. Computerized tomography and positron emission tomography (PET scanning) have lead to the common practice of clinical staging. With this evolution, some of the data concerning radiation therapy in the treatment of HL is dated.

There are several studies comparing limited field radiation therapy with broader radiation fields as the sole form of therapy in patients with limited stage HL. These studies are summarized in Table 73.1. The EORTCH 5 Trial included patients of age 40 or younger with nonbulky pathologic stage I and II, who and were considered a favorable risk group. Patients received mantle and periaortic radiation therapy versus mantle radiation therapy alone; no differences in disease-free survival (DFS) were seen between the two treatment groups.4 Regional radiation therapy was compared to involved-field radiation therapy (IFRT) in a BLNI Trial for pathologic stage IA and IIA patients; again, there were no difference in freedom from relapse (FFR).1

These data contrast two other studies that reported inferior outcome in pathologically staged patients when comparing limited field radiation therapy to broader fields. The Stanford trial compared subtotal lymphoid radiation therapy with IFRT in pathologically staged IA and IIA patients; FFR was significantly different (80% vs 32%), respectively.3 Significant differences in FFR was also found in the Collaborative clinical trial, favoring mantle/periaortic radiation therapy with IFRT.2 The Collaborative clinical trial also

Table 73.1 Limited versus extended radiation therapy for early stage HL

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