Background: Combined modality treatment (CMT) is currently considered standard of care in patients with early-stage unfavorable HL. By gradually increasing chemotherapy intensity an improvement of treatment efficacy and by reducing radiotherapy intensity a reduction of toxicity were attained. Long-term follow-up (FU) is needed to ensure the safety and efficacy of the applied therapies. Methods: We analyzed updated FU data of 2459 patients with early-stage unfavorable HL treated in the HD8 and HD 11 trial. In HD8 patients were randomized to either 30Gy IF- or extended-field (EF)-RT after 2xCOPP/ABVD and in HD11 patients received 20 or 30Gy IF-RT after 4xABVD or 4xBEACOPPbaseline. Progression-free (PFS) and overall survival (OS) were analyzed according to the Kaplan-Meier method. Cumulative incidences of secondary neoplasias (SN) were calculated and compared between groups using Pepe & Mori’s test. Results: The median FU was 153 and 106 months for patients in HD8 (n=1064) and HD11 (n=1395), respectively. New FU data were available for less than 50% of patients and last information was obtained from population registries in 23-27%. In HD8, non-inferiority of IF- compared to EF-RT was confirmed with HRs of 0.98 (95% confidence interval CI: 0.76-1.25) and 0.88 (CI:0.66-1.16) for PFS and OS, respectively. We observed a non-significant trend towards more SN (15-year cumulative incidence 17.1% versus 14.2%, respectively, p=0.3) and deaths from SN after EF-RT versus IF-RT. In HD11, no difference in PFS was found with BEACOPPbaseline compared to ABVD when followed by 30Gy IF-RT (HR: 1.1 (CI: 0.7-1.5)). In contrast, there was a significant difference in 10-year PFS rates estimated at 77.6% versus 83.3% in ABVD-treated patients who had received 20Gy instead of 30Gy IF-RT with a HR of 1.5 (CI: 1.0-2.1). After BEACOPPbas, 20Gy were non-inferior to 30Gy IF-RT with a HR of 1.0 (CI: 0.7-1.5) for PFS. No differences in terms of OS or SN were observed. Summary: Moderate intensification of chemotherapy does not improve the outcome but might facilitate the reduction of IF-RT-dose. Continued FU is necessary to assess long-term toxicity of the applied treatment strategies. 10-year PFS and OS estimates in early-stage unfavorable HL treated with 4xABVD + 30Gy IF-RT leave room for improvement.