Faculty Bibliography

The purpose of this large observational study was to examine outcomes in Hodgkin lymphoma(HL) patients by timing to definitive chemotherapy(TTC) using standard and propensity score (PS)-adjusted Cox proportional hazards models. From 1998-2011, 56,457 patients with stage I-IV HL were studied, with a median follow-up of 6.0 years(median age=39). Median TTC was 26 days from diagnosis. The cohort of "early"(<60 days from diagnosis) TTC patients included 45,307(80.3%) patients and "late"(>/=60 days) TTC was 11,150(19.7%). Patients were more likely to experience early TTC if they were younger age, advanced stage, with "B" symptoms, favorably insured, favorable socioeconomic status, and treated at comprehensive cancer center(all p<0.05). Ten-year overall survival for patients with early TTC was 73.2% versus 70.0% for those with late TTC(HR=0.87;95%CI,0.83-0.92,p<0.0001). After PS-matching for co-variates, early TTC was not associated with overall survival (HR=0.96;95%CI,0.85-1.08,p=0.51). This represents the only study to evaluate overall survival by time to definitive treatment for HL.

The purpose of this study was to use the National Cancer Database to examine the association between radiation therapy(RT) and overall survival(OS) in early-stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) using standard and propensity score (PS)-adjusted Cox proportional hazards models. From 1998-2011, 1,915 patients with stage I/II NLPHL were studied, with a median follow-up of 6.6 years (median age=44). Of the cohort, 1,224(64%) received RT(alone or with chemotherapy) to a median dose of 30.6 Gy. Patients were more likely to receive RT if male, younger age, lower stage, no "B"-symptoms, favorably insured, and treatment at comprehensive centers(all p<0.05). Patients administered RT had an improved 5-year OS (HR=0.62;95%CI,0.43-0.89,p=0.01). After PS-matching (n=868) based on all known co-variates, RT use trended towards improved OS (HR=0.49;95%CI,0.23-1.05,p=0.06). This study represents one of the largest prospective datasets examining the role of RT for stage I/II NLPHL and inclusion of RT may be considered.

PURPOSE: The purpose of this study was to compare outcomes with Hodgkin lymphoma (HL) patients receiving IMRT (intensity-modulated radiation therapy), versus those receiving 2D/3D-CRT (3-dimensional conformal RT) in a large observational cohort. PATIENTS AND METHODS: We evaluated patients diagnosed with stage I-IV HL from 1998 to 2011 from the National Cancer Database (NCDB). The association between IMRT use vs. 2D/3D-CRT, co-variables, and outcome was assessed in a Cox proportional hazards model. Propensity score (PS) matching was performed to balance known confounding factors. Survival was estimated using the Kaplan-Meier method. RESULTS: Of the 76,672 patients with HL within the NCDB, 12,393 patients with stage I-IV HL received RT (median dose=30.6Gy) and were eligible for this study, and 6013 patients analyzed for overall survival. The cohort had a median follow-up of 6.2years and median age of 37years (range: 18-90). The RT modalities used were: 2D/3D-CRT (n=11,491, 92.7%) or IMRT (n=902, 7.3%). Patients were more likely to receive IMRT if they were of male gender, early stage, no "B" symptoms, and treated at comprehensive cancer programs (all p<0.05). During this time period, there was a significant decrease in use of 2D/3D-CRT from 100% to 81.5%, with a subsequent increase in IMRT utilization from 0% to 18.5%. Five-year overall survival for patients receiving 2D/3D-CRT (n=5844) was 89.9% versus 95.2% for those receiving IMRT (n=169; HR=0.45; 95% CI, 0.23-0.91, p=0.02). After PS-matching based on clinicopathologic characteristics, IMRT use remained associated with improved overall survival (HR=0.40; 95% CI, 0.16-0.97, p=0.04). CONCLUSIONS: Our study reveals that HL patients receiving modern RT techniques were associated with an improvement in overall survival. This may have been related to patient selection, access to improved staging and management, or improvements in treatment technology. This represents the only study examining survival outcomes of advanced RT modalities, which may be considered on a case-by-case basis for highly selected patients with HL.

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 (