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#Unfolder trial trial
Thus, the recommendation in the following HD18 trial remained radiotherapy for lesions of at least 2.5 cm in the largest diameter with residual fluorodeoxyglucose (FDG) uptake after chemotherapy. The RATHL trial confirmed these results by omitting radiotherapy in PET-CT negative patients without a loss of disease control. The German HD 15 trial found that the omission of radiotherapy in patients with a complete metabolic response was noninferior (4-year PFS 92%) compared to patients with a positive PET-CT after chemotherapy and additional RT (4-year PFS 86%). The main treatment modality of advanced Hodgkin lymphoma is combination chemotherapy. To further reduce late complications, the German HD 17 trial showed that consolidation radiotherapy could be omitted without a clinically relevant loss of tumor control in patients with a negative PET-CT after systemic therapy with the 2 + 2 regimen.
#Unfolder trial plus
The German HD14 trial introduced an intensified chemotherapy regimen consisting of 2 cycles eBEACOPP plus 2 cycles ABVD (2 + 2) followed by 30 Gy involved field radiotherapy. The standard treatment in unfavorable HL was a combination of four cycles of chemotherapy and consolidation radiotherapy with a dose of 30 Gy.
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Early stage classical Hodgkin lymphoma with unfavorable prognostic factors The RAPID trial and the EORTC H10 trial confirmed these findings with a 3-year progression-free survival (PFS) of 97% in the radiotherapy group versus 90% in the group of no radiotherapy and a 5-year PFS of 99% versus 87% in PET-CT negative patients, respectively. Attempts to reduce chemotherapy in the German HD13 trial and to omit radiotherapy in PET-CT negative patients after chemotherapy in the German HD 16 trial resulted in relevant loss of tumor control. The protocol of the German HD10 trial with two cycles of ABVD followed by 20 Gy of INRT or ISRT is currently the state-of-the-art treatment approach. Extended-field radiation, where adjacent regions are also treated, was replaced by involved-site and involved-node radiation fields regions, depending on the quality and accuracy of the prechemotherapy imaging. Therefore, RT should maintain its effectiveness in local control, while minimizing radiation dose to normal tissue. With increasing effectiveness of curative approaches, a reduction in late side effects and an increase in quality of life is gaining importance. In the combined treatment modality for HL, RT improves locoregional control and overall outcome. Five-year relative survival rates of 96.4% and 89.8% were reported for patients diagnosed at the age of 0–19 years and of 20–64 years, respectively. While for some HL patients, radiotherapy alone still plays a role as a single modality in early stage lymphocyte-predominant HL, it is now mostly used in combination with chemotherapy with high cure rates. In HL, radiotherapy has traditionally been used as a primary treatment modality with excellent tumor control albeit there were significant challenges due to treatment-related morbidity. Studies with direct implications on clinical practice guidelines are summarized in Table 1. The aim of this short review is to outline the current treatment approaches in radiotherapy of common lymphomas and to discuss their clinical relevance.
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For localized follicular lymphoma (FL) and mantel cell lymphomas (MCL) where chemotherapy is less effective, radiotherapy alone is still the treatment of choice. In several types of NHL, radiotherapy has become a secondary modality for consolidation and reduction of relapse risk after chemotherapy. With the advent of effective and less toxic chemotherapy, the use of radiotherapy has gradually declined in terms of field size and dose. In the first half of the 20th century, patients with early stage Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) could be cured by radiotherapy alone however, it was also associated with the development of late complications and increased mortality due to the need of extended fields and high dose levels. Radiotherapy is a highly effective treatment method for the majority of lymphomas.