Early-stage classic Hodgkin lymphoma: The utilization of radiation therapy and its impact on overall survival Journal Article


Authors: Parikh, R. R.; Grossbard, M. L.; Harrison, L. B.; Yahalom, J.
Article Title: Early-stage classic Hodgkin lymphoma: The utilization of radiation therapy and its impact on overall survival
Abstract: Purpose To examine the association between radiation therapy (RT) utilization and overall survival (OS) for patients with early-stage Hodgkin lymphoma (HL). Methods and Materials Using the National Cancer Database, we evaluated clinical features and survival outcomes among patients diagnosed with stage I/II HL from 1998 to 2011. The association between RT use, covariables, and outcome was assessed in a Cox proportional hazards regression model. Propensity score matching was performed to balance observed confounding factors. Survival was estimated using the Kaplan-Meier method. Results Among the 41,943 patients in the National Cancer Database with stage I/II HL, 29,752 patients were analyzed for this study. Radiation therapy use was associated with younger age (40 years), favorable insured status, higher socioeconomic status (income, education), and treatment at comprehensive community cancer centers (all P 05). Five-year OS for patients receiving RT was 94.5%, versus 88.9% for those not receiving RT (P 01). Radiation therapy use was a significant predictor of OS in the "As-Treated" cohort (hazard ratio 0.53, 95% confidence interval 0.49-0.58, P 01) and intention-to-treat analysis (P 01). After propensity score matching based on clinicopathologic characteristics, RT use remained associated with improved OS (hazard ratio 0.46, 95% confidence interval 0.38-0.56, P 01). Over the study period, RT utilization for this cohort decreased from 55% to 44%, most commonly because it was not part of the planned initial treatment strategy. Conclusions Consolidation RT was associated with improved OS for patients with early-stage classic HL. We also have identified patient-specific variations in the use of RT that may be targeted to improve patient access to care. © 2015 Elsevier Inc. All rights reserved.
Keywords: adult; controlled study; major clinical study; overall survival; clinical feature; conference paper; cancer radiotherapy; cancer staging; outcome assessment; positron emission tomography; controlled clinical trial; radiotherapy; patient monitoring; data base; oncology; retrospective study; confidence interval; social status; health care utilization; medicaid; cancer center; education; multicenter study; patient treatment; regression analysis; diseases; income; classical hodgkin lymphoma; proportional hazards; hazards; initial treatment; methods and materials; intention to treat analysis; human; male; female; priority journal; kaplan-meier method; clinical features; medically uninsured; propensity score matching; socio-economic status
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 93
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2015-11-01
Start Page: 684
End Page: 693
Language: English
DOI: 10.1016/j.ijrobp.2015.06.039
PROVIDER: scopus
PUBMED: 26279323
DOI/URL:
Notes: Presented in part at the 56th Annual Meeting of the American Society for Radiation Oncology; 2014 Sep 14-17; San Francisco, CA -- Export Date: 2 November 2015 -- Source: Scopus
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  1. Joachim Yahalom
    508 Yahalom