Among patients with Stage IA or IIA nonbulky Hodgkin’s lymphoma, treatment with chemotherapy alone resulted in better overall survival than treatment that included radiation therapy. These results were published in the New England Journal of Medicine.
Hodgkin’s lymphoma is a cancer of the lymph system. It is diagnosed by the presence of a cell that is characteristic of the disease, the Reed-Sternberg cell. Hodgkin’s lymphoma typically begins in the lymph nodes in one region of the body and then spreads throughout the lymph system. It may spread outside the lymph system to other organs, such as the lungs, liver, bone, and bone marrow.
A chemotherapy regimen known as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is commonly used in the initial treatment of Hodgkin’s lymphoma. Treatment with both ABVD and radiation therapy is effective in controlling Hodgkin’s lymphoma, but can cause later, radiation-related health problems.
To explore the use of chemotherapy alone in the management of limited Hodgkin’s lymphoma, researchers conducted a clinical trial among 405 patients with previously untreated, Stage IA or Stage IIA non-bulky Hodgkin’s lymphoma. Half the patients received chemotherapy alone and half received treatment that included radiation therapy. Radiation was given alone or in combination with chemotherapy, depending on the characteristics of the cancer.
- 12-year overall survival was 94 percent among patients treated with chemotherapy alone, compared with 87 percent among patients who received radiation therapy (with or without chemotherapy).
- Among the patients treated with chemotherapy alone, 6 patients died from Hodgkin’s lymphoma or an early treatment complication and 6 died from another cause.
- Among the patients given treatment that included radiation therapy, 4 patients died from Hodgkin’s lymphoma or an early treatment complication and 20 died from another cause.
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These results suggest that for patients with limited Hodgkin’s lymphoma, treatment with chemotherapy alone resulted in better overall survival than treatment that included radiation therapy. Avoidance of radiation therapy reduced the risk of death from other causes.
A limitation of this study is that it began at a time when a more intensive radiation therapy regimen was used. It’s uncertain whether the results of this study would be the same if patients were treated with current approaches to radiation therapy, which may produce fewer long-term health problems.
An accompanying editorial notes “Although radiation therapy remains a useful tool for the treatment of some patients with Hodgkin’s lymphoma, the challenge is to define the subgroup of patients for whom the benefits outweigh the increased risk of late complications. Several recent clinical trials are attempting to address this issue…”
 Meyer RM, Gospodarowicz MK, Connors JM et al. ABVD alone versus radiation-based therapy in limited-stage Hodgkin’s Lymphoma. New EnglandJournal of Medicine. 2012;366:299-408.
 Straus DJ. Chemotherapy alone for early-stage Hodgkin’s lymphoma. New EnglandJournal of Medicine. 2012;366:470-471.