How would you treat an elderly patient with stage I/II unfavorable classic Hodgkin Lymphoma, who could only tolerate 2 cycles of chemotherapy and has a Deauville 1-2 PET/CT re-staging scan?
Glad this person had a good early response. If can't tolerate full course standard chemo, would treat with 20-30 Gy ISRT - treating only original sites of disease. The H10 (Federico et al., PMID 37967311) demonstrated a 13.4% benefit of RT at 10 years after ABVD x4 alone with a negative interim PET....
We do not have data for omission of RT in early stage unfavorable disease after only 2 cycles of RT. For example, HD17 tested this, but only after 2x BEACOPP esc + 2x ABVD. There is also data for omission of RT in good responders with more modern regimes, but none for omitting all therapy only after...
Assuming a patient is responding favorably to therapy by PET/CT, there are 5 regimens that are supported by randomized trials and included in national guidelines:
Chemotherapy-alone regimens
- ABVD x 2 + AVD x 4 (RATHL)
- BrECADD x 4 (HD21)
Combined modality therapy regimens
- ABVD x 4 + RT (30 Gy) (H1...