A 28-year-old woman is diagnosed with Hodgkin lymphoma, nodular sclerosis type, stage IIA with bulky mediastinal disease (mass > 1/3 chest diameter). Current standard of care per GHSG HD17 trial principles favours:
- A ABVD for 2 cycles followed by PET; if PET-negative (Deauville 1–3) omit radiotherapy; if positive, add 30 Gy INRT ✓
- B PET-adapted escalated BEACOPP to avoid radiotherapy if PET-negative after 2 cycles
- C Stanford V for 12 weeks followed by consolidation ISRT to all initial disease sites
- D 4 cycles ABVD followed by mandatory involved-site radiotherapy regardless of PET response
Explanation
HD17 (NEJM 2021) evaluated PET-guided omission of radiotherapy in favourable/intermediate-stage HL treated with eBEACOPP, but for early-stage HL (GHSG favourable/unfavourable), the RAPID and RATHL trials (and GITIL/FIL HD0801) established the PET-adapted paradigm: 2 cycles ABVD, then interim PET; Deauville 1–3 (PET-negative) allows omission of radiotherapy or de-escalation to ABVD alone, while PET-positive patients proceed to escalated therapy + radiotherapy. This avoids long-term radiation sequelae in young women (breast cancer risk) without compromising disease control.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.