The use of modern limited-field (LF)-radiotherapy after 2 or 4 doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) cycles may reduce, but not eliminate, excess long-term morbidity among patients with stage I-IIa classical Hodgkin lymphoma (cHL), according to research published in the Journal of Clinical Oncology.

Stage I-IIa cHL is generally regarded as highly treatable, with a 5-year disease-free survival rate of more than 90%, according to previously published research. Radiotherapy is, furthermore, a cornerstone of early-stage cHL treatment.

Before the year 2000, however, cHL treatments were linked with excess long-term morbidities, including diseases of the circulatory system (DCSs), secondary cancers, and diseases of the respiratory system (DRSs). The reduction of radiotherapy doses, as well as the advent of novel therapies, has helped to reduce the risk of such toxicities.

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Few previously published studies have established whether reduced radiotherapy dosage and LFs effectively mitigate against or eliminate excess long-term morbidity. For this study, researchers evaluated long-term outcomes among patients with stage I-IIa cHL who received modern LF-radiotherapy after 2 or 4 ABVD cycles.

Overall, data from 215 patients were included in this study and matched against 860 healthy controls. Between the patient and health control groups, the majority (59% in each) were between the ages of 18 and 39 years at study inclusion, 50% in both groups were male sex, 6% and 4%, respectively, had a previous malignancy diagnosis, 6% and 7% had a previous DCS diagnosis, and 3% in both groups had a previous DRS diagnosis.

All patients received treatment between 1999 and 2005; the median follow-up was 16 years. Analysis showed that malignancy risk (hazard ratio [HR], 1.5; 95% CI: 1-2.4), DCS risk (HR, 1.5; 95% CI, 1.1-2), and DRS risk (HR, 2.6; 95% CI, 1.6-4.3) were all higher in the patient population than among healthy controls. Venous thromboembolism was, however, the only DCS that was significantly more likely among patients.

Asthma (HR, 3.5; 95% CI, 1.8-6.8) constituted most of the observed risk for DRS. First DRS was more likely to be diagnosed at a younger age in patients (median, 46 years), than among healthy controls (median, 65 years).

“Persisting pulmonary toxicity may be misdiagnosed as asthma,” the authors noted. “As excess morbidity is not eliminated, the goal of omitting [radiotherapy] in early-stage cHL, when possible without compromising disease control, remains important.”

Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Lagerlöf I, Fohlin H, Enblad G, et al. Limited, but not eliminated, excess long-term morbidity in stage I-IIa Hodgkin lymphoma treated with doxorubicin, bleomycin, vinblastine, and dacarbazine and limited-field radiotherapy. J Clin Oncol. Published online January 25, 2022. doi:10.1200/JCO.21.02407