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Early>stage! Hodgkin! lymphoma! is! a! highly! curable! disease! with! a! combination! of!
chemotherapy,! i.e! ABVD,! and! radiotherapy.! Recent! studies! focused! on! the! reduction! of!
toxicities!while!maintaining!the!excellent!results!and!are!summarized!in!ESMO!guidelines!for!
Hodgkin’s!lymphoma!published!in!2018.!!
The!first!attitude!proposed!in!these!guidelines!is!the!result!of!the!HD10!study!performed!by!
the!German!Hodgkin!Study!Group!(GHSG)!and!suggested!to!use!2!cycles!of!ABVD!plus!20!cGy!
Involved!site!radiotherapy!(ISRT).!The!HD10!study,!showed!that!2!cycles!are!non>inferior!to!4!
cycles!and!that!20!cGy!ISRT!is!non>inferior!to!30!cGy!ISRT!1.!After!this!HD10!study,!the!GHSG!
performed!a!PET!based!study!(HD16)!randomizing!the!combined!modality!treatment!versus!
only! 2! cycles! of! ABVD! for! the! patients! Pet! negative! after! 2! cycles! of! ABVD.! This! study!
including!1150!patients!was!not!able!to!show!the!non>inferiority!of!the!ABVD!only!arm.!The!5!
years! progression>free! survival! (PFS)! was! 93.4%! (95%! CI:! 90.4>96.5)! in! the! combined!
modality!arm!versus!86.1%!(95%!CI:!81.4%>90.9%)!in!the!ABVD!only!arm!(p>value:!0.04).!
!
The! LYSA/EORTC/FIL! study! named! H10! evaluated! a! PET! based! approach! 2.! All! patients!
received! 2! cycles! of! ABVD! and! a! PET! scan! (PET2).! The! large! majority! of! the! patients! will!
become!PET2!negative!(Deauville!score!(DS)!1>3)!and!received!1!additional!cycle!of!ABVD!and!
20! cGy! ISRT! in! the! standard! arm! versus! chemotherapy! only! (2! additional! ABVD)! in! the!
experimental!arm.!The!study!was!not!able!to!show!the!non>inferiority!of!the!no!radiotherapy!
arm.! However,! for! the! minority! of! patients! that! are! PET2! positive! (DS! 4>5),! the! study!
demonstrated!a!benefit!in!PFS!for!intensified!chemotherapy!(BEACOPPesc)!and!30!cGY!ISRT.!
!
The!RAPID!study!conducted!in!stage!IA!and!IIA!patients!evaluated!in!PET!negative!patients!30!
cGY! involved>field! radiotherapy! versus! no! further! treatment.! The! conclusion! of! this! trial! is!
similar! to! what! was! observed! in! HD16! and! H10:! on! the! basis! of! a! maximum! allowable!
difference!of!7!percentage!points,!this!study!did!not!show!non>inferiority!of!the!strategy!of!
no!further!treatment!3.!
!
Despite! the! fact! that! PET2! evaluation! was! not! able! to! determine! a! subset! of! patients! that!
could! avoid! radiotherapy,! the! outcome! of! the! patients! treated! without! radiotherapy! was!
very! good.! An! individualized! approach! is! certainly! warranted! for! patients! who! could!
experience! an! important! toxicity! from! radiotherapy! and! should! be! discussed! in! young!
patients!receiving!mediastinal!radiotherapy.!
!R
eferences:(
1.! Engert! A,! Plutschow! A,! Eich! HT,! et! al.! Reduced! treatment! intensity! in! patients! with! early>
stage!Hodgkin's!lymphoma.!N(Engl(J(Med!2010;!363(7):!640>52.!
2.! Andre! MPE,! Girinsky! T,! Federico! M,! et! al.! Early! Positron! Emission! Tomography! Response>
Adapted! Treatment! in! Stage! I! and! II! Hodgkin! Lymphoma:! Final! Results! of! the! Randomized!
EORTC/LYSA/FIL!H10!Trial.!J(Clin(Oncol!2017;!35(16):!1786>94.!
3.! Radford!J,!Illidge!T,!Counsell!N,!et!al.!Results!of!a!trial!of!PET>directed!therapy!for!early>stage!
Hodgkin's!lymphoma.!N(Engl(J(Med!2015;!372(17):!1598>607.! !