Involved-Field Radiotherapy in Patients with Stage III/IV Hodgkin's Lymphoma: First Results of the Randomized EORTC Trial # 20884

William Levin, MD
University of Pennsylvania Cancer Center
Last Modified: November 5, 2001

Presenter: B.M. Aleman
Presenter's Affiliation: EORTC Lymphoma Group, Brussels, Belgium
Type of Session: Plenary

While the role of radiation therapy in the treatment of early stage Hodgkins Disease is well established, its utility in advanced disease is not as clear.

Materials and Methods

  • 736 patients were enrolled in a phase-III randomized trial comparing involved field radiotherapy (IFRT) versus no further treatment (no-RT) in patients with stage III/IV HL, who reached CR after standard MOPP/ABV chemotherapy.
  • Patients in early CR (after 4 cycles) received a total of 6 cycles while those in late CR (after 6 cycles) were given 8 courses.
  • Patients were randomized after the last chemotherapy cycle.
  • IFRT was performed as follows: 24 Gy to all initially involved nodal areas and 16-24 Gy to all initially involved extranodal areas, in fractions of 1.5-2.0 Gy, 5 fractions a week.
  • Partial responders (PR) after 6 cycles of MOPP/ABV were treated with IFRT to all initially involved lymph node areas and all initially involved organs.
  • The dose delivered to nodal areas and initially involved organs depended on their clinical status.
  • In case of CR after chemotherapy, the dose was the same as in CR patients.
  • In case of PR, 30 Gy were delivered to nodal areas and 18-24 Gy to extranodal sites with localized boost of 4-10 Gy where necessary.
  • The dose per fraction was 1.5-2.0 Gy on nodal areas.
  • The main endpoints were relapse-free survival (RFS), event-free survival (EFS) and overall survival (OS).


  • The mean age was 36 years; 80% had mediastinal involvement (of whom 35% bulky); 42% had stage IV disease.
  • After chemotherapy 60% reached a CR, 35% a PR, <1 % had no change, 2% had progressive disease (PD) and 2 % have died.
  • From the 418 patients who reached a CR, 161 patients were randomized to receive no RT and 172 patients to IFRT.
  • After a median follow-up of 6 years, no significant differences were observed in the randomized patients.
  • The 5-year RFS, 5-year EFS and 5-year OS rates were 85%, 82%, and 89%, respectively, for the no-RT group and 87%, 79% and 85%, respectively, for the IFRT group.
  • Among the 243 PR patients after chemotherapy, the 5-year EFS and 5-year OS rates were 80% and 87%.

    Author's Conclusions

  • IFRT does not improve the treatment results in patients with stage III/IV HL who reach CR after standard MOPP/ABV chemotherapy.
  • In partial responders after 6 cycles of MOPP/ABV the addition of IFRT induces similar overall survival and event-free survival rates as those of CR patients after chemotherapy.

    Clinical/Scientific Implications
    The results of this study suggest that there is no role for involved field radiation therapy in patients with stage III/IV Hodgkins disease who achieve a complete response after full dose chemotherapy. Partial responders benefit from the addition of IFRT, and can achieve survival rates similar to complete responders.

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