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. 2010 Mar;95(3):494-500.
doi: 10.3324/haematol.2009.015644. Epub 2009 Nov 30.

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Christine Herbst  1 , Fareed A Rehan, Corinne Brillant, Julia Bohlius, Nicole Skoetz, Holger Schulz, Ina Monsef, Lena Specht, Andreas Engert
Affiliations

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Christine Herbst et al. Haematologica. 2010 Mar.

Abstract

Combined modality treatment (CMT) of chemotherapy followed by localized radiotherapy is standard treatment for patients with early stage Hodgkin's lymphoma. However, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. We thus performed a systematic review with meta-analysis of randomized controlled trials comparing chemotherapy alone with CMT in patients with early stage Hodgkin's lymphoma with respect to response rate, tumor control and overall survival (OS). We searched Medline, EMBASE and the Cochrane Library as well as conference proceedings from January 1980 to February 2009 for randomized controlled trials comparing chemotherapy alone versus the same chemotherapy regimen plus radiotherapy. Progression free survival and similar outcomes were analyzed together as tumor control. Effect measures used were hazard ratios for OS and tumor control as well as relative risks for complete response (CR). Meta-analyses were performed using RevMan5. Five randomized controlled trials involving 1,245 patients were included. The hazard ratio (HR) was 0.41 (95% confidence interval (CI) 0.25 to 0.66) for tumor control and 0.40 (95% CI 0.27 to 0.59) for OS for patients receiving CMT compared to chemotherapy alone. CR rates were similar between treatment groups. In sensitivity analyses another 6 trials were included that did not fulfill the inclusion criteria of our protocol but were considered relevant to the topic. These trials underlined the results of the main analysis. In conclusion, adding radiotherapy to chemotherapy improves tumor control and OS in patients with early stage Hodgkin's lymphoma.

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Figures

Figure 1.
Figure 1.
QUORUM diagram.
Figure 2.
Figure 2.
Meta-analysis of tumor control among patients with early stage Hodgkin’s lymphoma who received chemotherapy (CT) alone or chemotherapy and radiotherapy (CMT). Solid squares represent effect estimates for the single trials, the size of square represents the weight of individual studies in the meta-analysis. Horizontal lines indicate 95% confidence intervals (CIs). The width of diamonds shows the 95% confidence intervals for the pooled hazard ratios.
Figure 3.
Figure 3.
Meta-analysis of OS among patients with early stage Hodgkin’s lymphoma, who received chemotherapy (CT) alone or chemotherapy and radiotherapy (CMT). Solid squares represent effect estimates for the single trials, the size of square represents the weight of individual studies in the meta-analysis. Horizontal lines indicate 95% confidence intervals (CIs). The width of diamonds shows the 95% confidence intervals for the pooled hazard ratios.
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