Patterns of care and outcomes of early stage I–II Hodgkin lymphoma treated with or without radiation therapy

Abstract

Omission of radiotherapy in the upfront management of early-stage classic Hodgkin lymphoma (cHL) has become more common with time. We report patterns of care and outcomes of stage I–II cHL treated with chemotherapy (CT) only versus CT and radiotherapy (combined modality therapy, CMT). From the National Cancer Database, we identified 28,327 early-stage cHL patients treated with CT (n = 15,798) or CMT (n = 12,529) from 2004 to 2018. CMT utilization declined over the period from 58% to 34%. With median follow-up of 6.2 years, the 5- and 10-year overall survival for CT versus CMT was 93.3% versus 96.9% (p < 0.001) and 88.7% versus 93.5% (p < 0.001), respectively. On multivariable analysis, uninsured (OR 0.75, p < 0.001) and Black patients (OR 0.86, p = 0.02) were less likely to receive CMT, and treatment with CT was predictive of death (OR 2.0, p < 0.001). This report highlights real-world outcomes in early-stage cHL, with worse survival with CT and notable disparities in CMT utilization.

Keywords:

• Hodgkin lymphoma
• early stage
• radiation therapy
• combined modality therapy

Disclosure statement

All other authors have no conflicts of interest. Dr. Tao serves on a cholangiocarcinoma advisory board, outside this submitted work.

Data availability statement

All NCDB data are available through the American College of Surgeons. Research STATA code available on request.