PMID- 18838714
OWN - NLM
STAT- MEDLINE
DCOM- 20081204
LR  - 20101118
IS  - 1527-7755 (Electronic)
IS  - 0732-183X (Linking)
VI  - 26
IP  - 32
DP  - 2008 Nov 10
TI  - Involved-nodal radiation therapy as a component of combination therapy for 
      limited-stage Hodgkin's lymphoma: a question of field size.
PG  - 5170-4
LID - 10.1200/JCO.2007.15.1001 [doi]
AB  - PURPOSE: Combined-modality therapy is the standard of care for limited-stage 
      Hodgkin's lymphoma (HL). Radiation therapy has evolved from extended-field 
      radiation therapy (EFRT) to involved-field radiation therapy (IFRT), reducing 
      toxicity while maintaining high cure rates. Recent publications recommend a 
      further reduction to involved-nodal radiation therapy (INRT), however, this has 
      not been clinically validated. PATIENTS AND METHODS: We identified 325 patients 
      with limited-stage HL, diagnosed between May 1, 1989 and April 1, 2005, and 
      treated with chemotherapy and radiation therapy following era-specific 
      guidelines: EFRT until 1996; IFRT from 1996 to 2001; INRT < or = 5 cm from 2001 
      to the present. INRT < or = 5 cm was defined as the prechemotherapy nodal volume 
      with margins < or = 5 cm to account for physiological movement, set-up variation, 
      and the limitations of conventional simulation and radiation therapy techniques. 
      Exclusion criteria were age younger than 16, fluorine-18 fluorodeoxyglucose 
      positron emission tomography, non-doxorubicin, bleomycin, vinblastine, and 
      dacarbazine-like chemotherapy, and/or more than four chemotherapy cycles. 
      RESULTS: At diagnosis, median age was 35 years; 52% male; stage IA 29%; stage IIA 
      71%. Ninety-five percent of patients received two chemotherapy cycles. The three 
      radiation therapy groups were: EFRT, 39%; IFRT, 30%; and INRT < or = 5 cm, 31%. 
      Median follow-up of living patients was 80 months. Median time to relapse was 37 
      months. Twelve relapses occurred: four after EFRT (3%); five after IFRT (5%); and 
      three after INRT < or = 5 cm (3%; P = .9). No marginal recurrences occurred after 
      INRT < or = 5 cm. Locoregional relapse (LRR) occurred in five patients: three 
      after EFRT; two with IFRT; and none with INRT < or = 5 cm. At 5 years, 
      progression-free survival (PFS) was 97%, and overall survival (OS) was 95%. At 10 
      years, PFS and OS were 95% and 90%, respectively. CONCLUSION: Reduction in field 
      size appears to be safe, without an increased risk of LRR in patients receiving 
      INRT < or = 5 cm.
FAU - Campbell, Belinda A
AU  - Campbell BA
AD  - Department of Radiation Oncology, Pathology, and Medical Oncology, British 
      Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada. 
      Bcampbell3@bccancer.bc.ca
FAU - Voss, Nick
AU  - Voss N
FAU - Pickles, Tom
AU  - Pickles T
FAU - Morris, James
AU  - Morris J
FAU - Gascoyne, Randy D
AU  - Gascoyne RD
FAU - Savage, Kerry J
AU  - Savage KJ
FAU - Connors, Joseph M
AU  - Connors JM
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20081006
PL  - United States
TA  - J Clin Oncol
JT  - Journal of clinical oncology : official journal of the American Society of 
      Clinical Oncology
JID - 8309333
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Chemotherapy, Adjuvant
MH  - Disease-Free Survival
MH  - Female
MH  - Hodgkin Disease/drug therapy/mortality/pathology/*radiotherapy
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Lymph Nodes/pathology/*radiation effects
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - Practice Guidelines as Topic
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Adjuvant/adverse effects
MH  - Recurrence
MH  - Registries
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2008/10/08 09:00
MHDA- 2008/12/17 09:00
CRDT- 2008/10/08 09:00
PHST- 2008/10/08 09:00 [pubmed]
PHST- 2008/12/17 09:00 [medline]
PHST- 2008/10/08 09:00 [entrez]
AID - JCO.2007.15.1001 [pii]
AID - 10.1200/JCO.2007.15.1001 [doi]
PST - ppublish
SO  - J Clin Oncol. 2008 Nov 10;26(32):5170-4. doi: 10.1200/JCO.2007.15.1001. Epub 2008 
      Oct 6.