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8 standard-of-care settings across 4 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | Age group |
|---|---|---|
| Screening, prevention and diagnosis | 1 | · |
| Early / localised | 4 | 1 |
| Special situations | 1 | · |
| Other settings | · | 1 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Staging | FDG-PET/CT with Lugano staging; bone marrow biopsy no longer needed when PET is used; fertility counselling and cardiac baseline. | NCCN Guidelines: Hodgkin Lymphoma | 80 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Early favourable disease | Two cycles of ABVD with 20 Gy involved-site radiotherapy (HD10); or PET-adapted chemotherapy alone (three ABVD if PET-negative after two, RAPID and H10) accepting a small increase in relapse. | NCCN Guidelines: Hodgkin Lymphoma | 93 | |
| All comers | Early unfavourable disease | Four cycles of ABVD (or two escalated BEACOPP plus two ABVD) with 30 Gy involved-site radiotherapy; radiotherapy omitted in PET-negative patients after HD17. | NCCN Guidelines: Hodgkin Lymphoma | 93 | |
| All comers | Early favourable Hodgkin lymphoma: two cycles of ABVD and 20 Gy, and the argument about leaving the radiotherapy out | GHSG HD10 established the smallest combined-modality treatment that works: two cycles of ABVD followed by 20 Gy involved-field radiotherapy gave five-year freedom from treatment failure of about 93 per cent and overall survival of about 97 per cent, with no advantage from four cycles or from 30 Gy, and fewer acute adverse events at the lower intensity. Four visits of chemotherapy and a fortnight of radiotherapy cure the great majority. Whether the radiotherapy can be dropped in patients whose PET is negative has been asked twice, and both answers were the same. HD16 randomised 1,150 patients: among 628 who were PET-negative after two cycles, five-year progression-free survival was 93.4 per cent with combined-modality treatment against 86.1 per cent with ABVD alone (difference 7.3 percentage points, hazard ratio 1.78), with five-year overall survival of 98.1 and 98.4 per cent. RAPID randomised patients whose PET was negative after three cycles and found three-year progression-free survival of 94.6 per cent with radiotherapy against 90.8 per cent without, with no difference in overall survival and non-inferiority not formally shown. So omitting radiotherapy costs a few percentage points of disease control and costs nothing in survival, while avoiding a field over the heart, breasts, thyroid and lungs in a person who will live another fifty years. It is a genuine choice and it is made differently by different patients and different countries. A Deauville score of 4 on the interim PET predicts a much higher risk of failure than a score of 3, and those patients keep the radiotherapy. | GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphomaRAPID: PET-directed therapy for early-stage Hodgkin lymphomaABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)DoxorubicinBleomycinVinblastineDacarbazineIMRT / IGRT (modern external beam)Deauville score and PET-adapted therapyFDG PETRadiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapyLate effects of Hodgkin lymphoma treatment, and the follow-up that answers them | NCCN · Category 1 | 93 |
| All comers | Early unfavourable Hodgkin lymphoma: more chemotherapy, and PET-guided intensification | Early-stage disease with risk factors (a large mediastinal mass, extranodal involvement, a raised erythrocyte sedimentation rate, three or four or more nodal areas, or age 50 or over depending on the criteria used) is treated with four cycles of chemotherapy and involved-site radiotherapy at 30 Gy, or with more intensive chemotherapy in place of some of it. EORTC/LYSA/FIL H10 randomised 1,950 patients and settled the PET-adapted question in both directions. In the 18.8 per cent whose PET after two cycles of ABVD was positive, switching to two cycles of escalated BEACOPP with involved-node radiotherapy raised five-year progression-free survival from 77.4 to 90.6 per cent (hazard ratio 0.42). In PET-negative patients, non-inferiority of ABVD alone could not be demonstrated in either the favourable group (99.0 against 87.1 per cent for combined-modality treatment) or the unfavourable group (92.1 against 89.6 per cent), so omitting radiotherapy again costs disease control. Brentuximab vedotin with AVD is an option for unfavourable early-stage disease in some guidelines, and AHOD2131, an international trial in patients aged 5 to 60 with stage I to II disease, is testing response-adapted brentuximab vedotin with nivolumab against standard therapy with or without radiation. That trial is the one most likely to change this row next. | AHOD2131 (COG / NCTN)ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)Brentuximab vedotinNivolumabDoxorubicinBleomycinVinblastineDacarbazineEtoposideCyclophosphamideProcarbazineIMRT / IGRT (modern external beam)FDG PETDeauville score and PET-adapted therapyRadiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy | NCCN · Category 1 | 98 |
| Age group | Children, adolescents and young adults with early-stage Hodgkin lymphoma | Paediatric protocols differ from adult ones in two ways that matter: they use response-adapted designs to remove radiotherapy from as many children as possible, and they avoid or limit the agents with the worst late effects in a growing body, particularly alkylating agents and chest radiotherapy. Children's Oncology Group and EuroNet protocols give a short course of multi-agent chemotherapy, assess response with PET after two cycles, and give involved-site radiotherapy only to sites that have not responded adequately. The aim is to cure more than 95 per cent of children with the smallest cumulative dose of anthracycline, alkylator and radiation they can be cured with. AHOD1331 showed the direction of travel in high-risk paediatric disease: replacing bleomycin with brentuximab vedotin gave three-year event-free survival of 92.1 per cent against 82.5 per cent (hazard ratio 0.41), with three-year overall survival of 99.3 against 98.5 per cent, similar toxicity and a similar proportion receiving radiotherapy (53.4 against 56.8 per cent). AHOD2131 is now testing brentuximab vedotin with nivolumab against standard therapy in early-stage disease across the ages of 5 to 60, which is unusual and deliberate: adolescents and young adults have historically fallen between paediatric and adult trials and done worse for it. Growth, fertility, thyroid function, cardiac function and psychological support are part of the treatment plan from the first appointment, not the end of it. | AHOD1331: brentuximab vedotin with chemotherapy in paediatric high-risk Hodgkin lymphomaAHOD2131 (COG / NCTN)Brentuximab vedotinNivolumabBleomycinDoxorubicinIMRT / IGRT (modern external beam)FDG PETFertility before lymphoma treatment: what to ask for, and whenLate effects of Hodgkin lymphoma treatment, and the follow-up that answers them | NCI PDQ childhood Hodgkin lymphoma; COG and EuroNet protocols; AHOD1331 | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Survivorship | Cardiac surveillance, breast screening from eight years after chest radiotherapy in women, thyroid checks and second-cancer awareness for life. | NCCN Guidelines: Hodgkin Lymphoma | 89 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Age group | Children and adolescents | Response-adapted Children's Oncology Group regimens with radiotherapy for slow responders; AHOD2131 tests brentuximab vedotin with nivolumab. | NCCN Guidelines: Hodgkin Lymphoma | 98 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.