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Cochrane on Optimizing Chemo, Radiotherapy for HL

Cochrane; 2017 Sep 4; Franklin, Eichenauer, et al

Intensified chemotherapy regimens work better in people with Hodgkin lymphoma, though patients face an increased risk of secondary acute myeloid leukemia, according to a Cochrane review of 16 trials involving nearly 3,000 individuals. The trials compared 1) chemotherapy with or without additional radiotherapy; 2) a more extensive or more restricted radiation field; 3) higher or lower radiation dose; 4) more or fewer courses of chemotherapy; and 5) standard-dose or dose-intensified chemotherapy. Among the findings:

  • Chemotherapy without additional radiotherapy was linked with a lower second cancer risk but also possibly more disease growth/regrowth.
  • Second cancer risk, overall survival, and Hodgkin-free survival was similar regardless of the radiation field treated.
  • The same was true when comparing 1) chemotherapy with lower- vs higher-dose radiation and 2) fewer vs more courses of chemotherapy.
  • Dose-intensified chemotherapy improved Hodgkin-free survival, but increased the risk of secondary leukemia.
  • While intensified chemotherapy’s impact on overall survival was not conclusive, escalated-dose BEACOPP seemed to lengthen survival.


Franklin J, Eichenauer D, Becker I, Monsef I, Engert A. Optimisation of chemotherapy and radiotherapy for untreated Hodgkin lymphoma patients with respect to second malignant neoplasms, overall and progression-free survival: Individual participant data analysis. Cochrane Database of Systematic Reviews. 2017, Issue 9. Art. No.: CD008814. doi:10.1002/14651858.CD008814.pub2.