Assessing Acute Side Effects in Hodgkin's Lymphoma Patients Undergoing Radiation Therapy: A Comparison of Sequential and Non-Sequential RT Approaches

Abstract

Objective

To assess acute effects in radiation therapy (RT) for Hodgkin's Lymphoma (HL) after chemotherapy.

Method

HL patients treated from March 2017-January 2024 were retrospectively analyzed. Complete data for 63 out of an initial cohort of 100 patients was identified via a comprehensive review of treatment files and online database. Demographic, RT details along with acute effect profile was recorded.

Result

Among patients, 44.4%(n=28) were <10 years, 42.9%(n=27) 10-15 years and 12.7%(n=8) >15 years. Males constituted 77.8%(n=49) and females 22.2%(n=14). There were 3.2%(n=2) Stage I, 33.3%(n=21) Stage II, 38.1%(n=24) Stage III, 25.4%(n=16) Stage IV and 22.2%(n=18) Relapsed/Refractory cases.

RT included 3D-Conformal Radiation Therapy (3DCRT; 23.8%, n=15) and Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy (IMRT/VMAT; 76.2%, n=48) with a median dose of 2980 cGY in 42.9%(n=27). Sites were categorized into supradiaphragmatic only 30.2%(n=19), concurrent 60.3%(n=38), and infradiaphragmatic only 9.5%(n=6). Frequently treated sites included cervical region (88.95%, n=55), mediastinum (65.1%, n=41), para-aortic (58.7%, n=37), spleen (41.3%, n=26), axilla (39.7%, n=25), inguinal (17.5%, n=11), pelvis (14.3%, n=9) and skeletal region (9.5%, n=6). Among patients with both supra and infra diaphragmatic disease, 74.6% (n=47) received concurrent RT to both regions. Sequential RT for either lesion was done in 25.4% (n=16) patients. The majority (66.7%, n=42) experienced no treatment gaps.

In sequential RT, 11%(n=7) reported no acute effects, 6.3%(n=4) G1 mucositis, 1.6%(n=1) dysphagia and G1 dermatitis each. In non-sequential RT, 38.1%(n=24) reported no acute effects, 22.2%(n=14) G1 dermatitis, 17.5%(n=11) dysphagia, 11.1%(n=7) G1 mucositis and G2 mucositis each, 9.5%(n=6) vomiting, 7.9%(n=5) nausea, 4.8%(n=3) G2 dermatitis, 1.6%(n=1) G3 mucositis and nodal swelling each.

Conclusion

Our study highlights the reduced incidence of acute effects with the introduction of conformal RT techniques. Even among those receiving concurrent supra and infra diaphragmatic RT, majority experienced no acute effects, and those who did, tolerated them well.