We thank Oertel and Eich for their response to our article, which—in a somewhat loose connection to the subject—provides an overview of the role of radiotherapy in Hodgkin’s lymphoma (HL), which we support with regard to central issues raised.
As they correctly cited, we explicitly mentioned the context of the GHSG’s HD15 Study, which showed that in advanced stages after standard polychemotherapy (BEACOPPescalated), risk can be successfully stratified by using PET. In PET-negative patients, radiotherapy can be omitted, and the same applies for patients with PET-positive residual findings <2.5 cm (1). In this example, re-staging by using PET shows its potential for an individualized treatment adapted to the prognosis, among others with the aim of avoiding late toxicity, which is of particular relevance in mediastinal irradiation, which can, for example, include the development of secondary malignancies or early coronary heart disease (2).
As far as the UK RAPID Trial is concerned, progression-free three-year survival and overall survival after three cycles of ABVD and with negative findings on PET was 90.8% ad 99.0%, or 94.6% and 97.1% after radiotherapy. The authors concluded that patients with early stage HL and negative PET findings had a very good prognosis after three cycles of ABVD, with or without consolidating radiotherapy (3). The relative significance of a 4% difference in the recurrence rate after three years vis-à-vis the (late) toxicity of additional therapy is the subject of discussion in the context of this study.
The most recently conducted therapy optimization studies of the GHSG (HD16–17) also evaluated the importance of PET for the purpose of treatment stratification in the early and intermediate stages, as well as the question of whether in this disease context, radiotherapy can be omitted for selected patients. We fully agree that until these studies have been analyzed, radiotherapy remains the clinical care standard in these stages.
On behalf of the authors
Prof. Dr. med. Thorsten Derlin
Klinik für Nuklearmedizin
Medizinische Hochschule Hannover
Conflict of interest statement
Prof. Dr. Derlin received travel expenses from ROTOP Pharmaka. He received lecture fees from Janssen-Cilag. He received royalties for publications relating to this subject from the publishers Thieme and Springer.
|1.||Engert A, Haverkamp H, Kobe C, et al.: Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin‘s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 2012; 379: 1791–9 CrossRef|
|2.||Galper SL, Yu JB, Mauch PM, et al.: Clinically significant cardiac disease in patients with Hodgkin lymphoma treated with mediastinal irradiation. Blood 2011; 117: 412–8 CrossRef MEDLINE|
|3.||Radford J, Illidge T, Counsell N, et al.: Results of a trial of PET-directed therapy for early-stage Hodgkin‘s lymphoma. N Engl J Med 2015; 372: 1598–607 CrossRef MEDLINE|
|4.||Derlin T, Grünwald V, Steinbach J, Wester HJ, Ross TL: Molecular imaging in oncology using positron emission tomography (PET). Dtsch Arztebl Int 2018; 115: 175–81 VOLLTEXT|