Trends in Radiation Use from 2004 to 2020 among Adolescents and Young Adults with Hodgkin Lymphoma

Hodgkin lymphoma has excellent survival rates in adolescents and young adults (AYA, diagnosed between ages 15 and 39 years). However, survivors are at risk of treatment-related late effects. Whereas radiotherapy (RT) de-escalation/omission has emerged as an approach to minimize late effects, no prior studies have evaluated RT use over time in AYAs with Hodgkin lymphoma.

Using the National Cancer Database, we identified 40,717 AYAs diagnosed with Hodgkin lymphoma between 2004 and 2020. Differences in sociodemographic and clinical variables were assessed using a two-sample two-sided t test or χ2 test. RT use was summarized per year by frequency with 95% confidence intervals (CI). The association of RT receipt with sociodemographic and clinical variables was modeled using logistic regression.

Of the AYAs included, 20.1% received RT, with a significant decline in RT use over time from 33.9% in 2004 to 9.3% in 2020 (P < 0.0001). Use of mantle RT declined over time from 40% in 2004 to 0% in 2018 (P < 0.0001). Female AYAs were consistently less likely to receive RT than males. Rural versus metro setting (OR, 1.69; 95% CI, 1.34-2.14; P < 0.0001) and private versus no insurance (OR, 1.58; 95% CI, 1.42-1.76; P < 0.0001) were associated with greater RT use.

Use of RT in AYAs with Hodgkin lymphoma declined from 2004 to 2020, especially in female and uninsured AYAs.

Whereas use of RT declined overall for AYAs with Hodgkin lymphoma, this was not equal across groups. Research is needed to better understand disparities in RT use by rurality and insurance status. See related In the Spotlight, p. 1445.