Reduced Mortality Risk in the Recent Era in Early-Stage Hodgkin Lymphoma Patients Treated with Radiation Therapy With or Without Chemotherapy
Menée à partir de données portant sur 1 541 patients atteints d'un lymphome hodgkinien de stade I ou II traité entre 1968 et 2007 par radiothérapie en combinaison ou non avec d'autres traitements (âge médian au diagnostic : 27 ans ; durée médiane de suivi : 15,2 ans), cette étude multicentrique met en évidence, durant cette période, une réduction de la mortalité toutes causes confondues
Background : Long-term survivorship of Hodgkin lymphoma (HL) necessitates quantification of the late risk of mortality from HL and from other causes. We sought to determine the impact of treatment changes over time on all-cause mortality risk in early-stage HL patients following radiotherapy. Methods : An IRB-approved retrospective study was conducted using a multi-institutional database of 1,541 Stage I and II HL patients treated 1968-2007 with radiation therapy alone or combined modality treatment. Analytic methods included: cumulative incidence function, Kaplan-Meier estimates and log-rank tests for overall survival (OS) differences, and Cox proportional hazards model. Results : The median age at diagnosis was 27 years. At a median follow-up of 15.2 years (35% of patients with >20 years of follow-up), there were 395 deaths from all causes, including 85 HL, 168 second malignancy (25 hematologic, 143 non-hematologic), 70 cardiovascular, and 21 pulmonary deaths. Cumulative incidence of non-HL mortality surpassed HL mortality at 8.3 years. For patients treated 1968-1982, 1983-1992, and 1993-2007, the 15-year OS rates were 78%, 85% and 88%, respectively (p=0.0016). On Cox proportional hazards analysis, age, B symptoms and number of sites of disease were significantly associated with all-cause mortality in the first decade of follow up and there was a trend toward significance for radiation field extent. Conclusions : The all-cause mortality risk was significantly lower in patients treated in the most recent era during the first decade of follow-up, likely due to improved HL therapy resulting in a higher cure rate as well as lower treatment-related toxicity from smaller radiation fields. Current efforts toward radiation treatment reduction may further reduce long-term mortality risk in these patients.
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