Landgren O et al. (2006) A population-based cohort study on early-stage Hodgkin lymphoma treated with radiotherapy alone: with special reference to older patients. Ann Oncol 17: 1290–1295

Adding chemotherapy to radiotherapy regimens can increase response and relapse-free survival in patients with Hodgkin lymphoma (HL) who have an unfavorable prognosis; however, the poorer prognosis of older patients and their decreased tolerance of chemotherapy means that this group is usually initially treated with radiotherapy alone. Landgren et al. performed a long-term population-based cohort study in consecutive patients with early-stage HL treated initially with radiotherapy alone, and compared relapse rate, outcome and predictors of prognosis between older and younger patients.

Following radiotherapy, 218 (90%) of patients aged <60 years and 54 (82%) of those aged ≥60 years achieved complete remission. Relapse rates were similar between the two age-groups (42% in total), and neither gender nor age at diagnosis were associated with risk of relapse. The prognosis of older patients who relapsed and received rescue chemotherapy was similar to that shown in other studies for older patients treated initially with chemotherapy. There was no acute radiotherapy-related mortality, and the sites of secondary neoplasms were unrelated to applied radiation field in older patients, suggesting that radiotherapy was not the cause.

The authors conclude that there is no evidence of an age-related risk of relapse in older patients with early-stage HL treated with radiotherapy alone, and that this could be a suitable alternative first-line therapy in this group. They believe that the decision to use chemotherapy in older patients should be based on individual risk profile, projected benefit versus risk of iatrogenic morbidity/mortality, and consultation with the patient.