Background: With the introduction of Hodgkin lymphoma patients receiving
combined modality therapy, extended field radiation techniques were replaced
by involved field radiotherapy (IFRT). Recent research has demonstrated the
safety of further field site reductions. By using the idea of involved node
radiotherapy (INRT), the risk of radiation-induced toxicity can be decreased
without compromising the effectiveness of treatment. The foundation of INRT
is treating only the lymph nodes that were initially involved and omitting any
adjacent uninvolved nodal areas.
Patients and methods: 66 patients with early-stage Hodgkin's lymphoma were
collected within the previous five years in SECI and were classified into two
arms either IFRT or INRT after receiving chemotherapy according to disease
stage. Out of those patients thirty eight received (IF) and twenty eight received
(IN). Radiotherapy dose used for all patients was 20- 30 Gy. Patients were
assessed for treatment toxicity and local recurrence.
Results: Median follow up time of all patients was about 40 months. It was
found that involved INRT was not inferior to IFRT. No difference in efficacy
between both arms and also with comparable toxicity. Both groups had
comparable characteristics, laboratory data, and response to chemotherapy.
Relapse occurred in four patients (10.5%) in IFRT group and two patients
(7.1%) in INRT group. Also, both groups had insignificant difference as regard
overall survival 56.78 ± 2.40 vs. 56.78 ± 2.19 (months), of (IF) and (IN)
respectively with p- value of 0.30. Both groups had comparable early toxicity
and its grades, response and late toxicity (p> 0.05). Late complications as
hypothyroidism developed in three patients of IFRT group and two patients of
INRT group. Pulmonary fibrosis developed only in four (10.5%) patients of
IFRT group.
Conclusion: The main finding in this study is that (IN) is not inferior to (IF) as
regards efficacy and at least same toxicity therefore (IN) radiotherapy can
replace (IF).