Long-Term Outcomes in 10-Year Survivors of Early-Stage Hodgkin Lymphoma

James E. Bates, Rahul R. Parikh, Nancy P. Mendenhall, Christopher G. Morris, Richard T. Hoppe, Louis S. Constine, Bradford S. Hoppe

Research output: Contribution to journalArticle


Purpose: Although radiation therapy improves progression-free survival in early-stage Hodgkin lymphoma (HL), substantial concerns remain regarding the impact of delayed normal tissue effects on quality of life and survival. We hypothesized that treatment with combined-modality therapy (CMT; chemotherapy and radiation therapy) improves overall survival among 10-year survivors compared with treatment with radiation therapy or chemotherapy alone. Methods and Materials: We compared patients in the Surveillance, Epidemiology, and End Results database who received a diagnosis of stage I/II HL between 1983 and 2006 who received chemotherapy and/or external beam radiation and survived at least 10 years. Our primary study outcome was overall survival; we also analyzed cause-specific and other-cause-specific survival. Results: Of 10,443 ten-year survivors of stage I/II classical HL, 33.6% received chemotherapy alone, 23.8% radiation therapy alone, and 42.6% CMT. Median follow-up was 16.1 years. On multivariate analysis including race, stage, sex, age, and “modern” treatment in 1995 and later, 10-year survivors who received CMT had improved overall survival relative to survivors who received RT alone (hazard ratio, 1.41; 95% confidence interval, 1.21-1.64; P < .01) or chemotherapy alone (hazard ratio, 1.35; 95% confidence interval, 1.16-1.57; P < .01). Conclusions: This survival difference was driven by an increase in death from both HL and non-HL causes in those treated with chemotherapy alone. Our analysis suggests that CMT offers optimal survivorship for patients with stage I/II HL.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
StateAccepted/In press - Jan 1 2020

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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