First-line therapy for Hodgkin lymphoma (HL) is essentially based on polychemotherapies plus radiotherapy (radiotherapy, radiatio).
Radiotherapeutic measures in Hodgkin’s disease [according to S3 guideline]:
- Early stage (localized involvement in stage I-II without risk factors): patients with classic HL: after two cycles of ABVD chemotherapy (adriamycin=doxorubicin, bleomycin, vinblastine, and DTIC=dacarbzine), patients receive radiotherapy: conventional “involved-field” irradiation of the affected regions with 20 Gy, leaving out adjacent regions. Patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) without risk factors should be treated with 30 Gy ISRT alone (“involved site radiotherapy“). Note: In PET-positive remission (Deauville score ≥ 4) after chemotherapy with “2+2”, consolidative RT should be performed.After chemotherapy with 4 cycles of ABVD, consolidative RT with a dose of 30 Gy should be performed regardless of PET status.
- Intermediate stage:After chemotherapy with 2 cycles of BEACOPPescalated followed by 2 cycles of ABVD (“2+2”), consolidative RT with a dose of 30 Gy should be applied.
- Advanced stage: advanced stage patients who have received prior polychemotherapy and who have an indication for additive radiotherapy should be irradiated with a dose of 30 Gy.Recommended therapy is PET-2 adapted therapy with four to six cycles of eBEACOPP plus consecutive radiotherapy of PET-positive residuals.
- Patients with an indication for radiation therapy may be irradiated using intensity-modulated radiation therapy or volumetric-modulated radiation therapy.
- Patients who have responded to chemotherapy but show PET/CT-positive residual tissue should receive local radiation therapy.
Further notes
- In the HD11 study according to the BEACOPP (basic regimen), 20 Gy IF irradiation was found to be non-inferior to 30 Gy irradiation.
