A 42-year-old woman with Hodgkin lymphoma (nodular sclerosis, stage IIA, no bulk) achieves complete metabolic response (PET-CT Deauville score 1) after 2 cycles of ABVD. What is the current preferred management strategy?
- A Continue ABVD for 2 more cycles + involved-field radiation (IFRT) ✓
- B Continue ABVD for 6 cycles without radiotherapy
- C PET-adapted therapy: 2 cycles ABVD only (omit bleomycin) + consolidation RT
- D PET-adapted: 4 cycles ABVD then re-stage; add RT only if PET positive
Explanation
In early-stage favorable Hodgkin lymphoma (non-bulky stage I-IIA), PET-adapted strategies have been validated in RAPID and EORTC H10 trials. In the RAPID trial, patients achieving PET negativity (score ≤2) after 3 cycles were randomized to RT or no RT — while RT omission was non-inferior (marginally), current standard remains 2+2 cycles ABVD (4 total) + involved node/site RT for favorable early-stage disease. Combined modality therapy with abbreviated chemotherapy + ISRT remains standard per ESMO/NCCN for stage IIA non-bulky PET-negative disease given excellent 5-year PFS >90%.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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