According to an article recently published in the New England Journal of Medicine, chemotherapy plus involved-field radiation should become the standard of care for early-stage Hodgkin’s disease.
Hodgkin’s lymphoma is a cancer of the lymph system. It is diagnosed when a characteristic cell (the Reed-Sternberg cell) is present and identified under a microscope. Hodgkin’s lymphoma typically begins in the lymph nodes in one region of the body and then spreads through the lymph system in a predictable manner. It may spread outside the lymph system to other organs such as the lungs, liver, bone, and bone marrow.
Early-stage (Stage I or Stage II) Hodgkin’s lymphomas are sometimes further classified as “favorable” or “unfavorable” based on prognostic factors such as lab and pathology results, symptoms, and number of sites in the body where cancer can be detected (involved sites). Patients with early-stage unfavorable Hodgkin’s lymphoma are often treated with a combination of chemotherapy and radiation therapy; however, effective treatment for patients with early-stage favorable Hodgkin’s lymphoma has been less clear. The goal of treatment in this case is to increase long-term survival while maintaining quality of life.
Involved-field radiation therapy refers to radiation therapy that is administered to all lymph node regions known to contain cancer. Extended-field radiation therapy refers to radiation therapy that is administered to the involved lymph node regions as well as adjacent uninvolved lymph node regions. A concern with the use of extended-field radiation therapy is that it may increase side effects without improving survival.
Researchers from France recently conducted two clinical trials to evaluate different treatment options for patients with either favorable or unfavorable early-stage Hodgkin’s lymphoma. The trials included 1,538 patients who had not received prior therapy. Median follow-up for both trials was 92 months.
- The first trial, the H8-F trial, included patients with early-stage favorable Hodgkin’s who were treated with either three cycles of chemotherapy, referred to as MOPP (mechlorethamine, vincristine, procarbazine and prednisone); plus chemotherapy, referred to as ABV (doxorubicin, bleomycin and vinblastine); plus radiation therapy to involved sites. A second reference group was treated with radiation only. Results of this trial indicated that survival at 10 years was 97% for those treated with chemotherapy plus radiation therapy versus 92% for those treated with radiation therapy only.
- The second trial, the H8-U trial, included patients with early-stage unfavorable Hodgkin’s. One group was treated with either chemotherapy including six cycles of MOPP plus ABV plus radiation therapy. Another group received four cycles of MOPP/ABV plus radiation to involved sites. The remaining group received four cycles of MOPP/ABV plus radiation to involved lymph nodes. These results showed that survival at 10 years was 88% for patients treated with six cycles of chemotherapy plus radiation therapy, 85% for patients treated with chemotherapy plus radiation therapy, and 84% for patients treated with chemotherapy and radiation to the lymph nodes.
The researchers concluded: “Chemotherapy plus involved-field radiotherapy should be the standard treatment for Hodgkin’s disease with favorable prognostic features. In patients with unfavorable features, four courses of chemotherapy plus involved-field radiotherapy should be the standard treatment.”
Patienst with early-stage Hodgkin’s disease may wish to speak with their physician regarding their individual risks and benefits of treatment including both chemotherapy and radiation therapy.
Reference: Ferme C, Eghbali H, Meerwaldt J, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. New EnglandJournal of Medicine. 2007;357:1916-1927.
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