Treatment of early favorable hodgkin lymphoma

Early favorable Hodgkin lymphoma is defined as Ann Arbor stage I and II Hodgkin lymphoma without clinical risk factors. Historically, early favorable Hodgkin lymphoma became highly curable with large radiotherapy fields but at the cost of high early and late toxicity resulting in reduced long-term survival. The successful introduction of multiagent chemotherapy in Hodgkin lymphoma made it possible to combine chemotherapy with radiotherapy in smaller doses and fields. Last decades, efforts have been made to find optimal chemotherapy treatment with limited cycles (2–3) of ABVD combined with limited dose (20–30 Gy) involved-field and involved-node radiotherapy. Most recently, trials investigating PET response-adapted treatment showed that a significant progression-free survival benefit can be achieved by intensification of treatment in case of interim PET positivity after 2–3 cycles of ABVD. On the other hand, omission of radiotherapy in case of a negative interim PET results in poorer progression-free survival of about 7–12% with similar overall survival. Long-term effects of omitting radiotherapy on secondary malignancies and cardiovascular outcomes need to be awaited. A case-by-case weighing of expected long-term risk of current radiotherapy regimens against the limited decrease in progression-free survival should be performed to choose treatment with best short- and long-term outcomes.