More Radiation Therapy's not Better for Elderly Patients with Hodgkin’s Lymphoma
According to a study published in the Annals of Oncology, extended-field radiation therapy results in worse survival than involved-field radiation therapy among elderly patients with early-stage unfavorable Hodgkin’s lymphoma.
Hodgkin’s lymphoma is a cancer of the lymph system. It is diagnosed when a characteristic cell (the Reed-Sternberg cell) is 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 involved sites. Patients with early-stage unfavorable Hodgkin’s lymphoma are often treated with a combination of chemotherapy and radiation therapy.
Involved-field radiation therapy refers to radiation therapy that is administered to all lymph node regions that are 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.
To explore treatment outcomes following involved-field versus extended-field radiation therapy, researchers conducted a study among 1064 patients with early-stage unfavorable Hodgkin’s lymphoma. Elderly patients were the focus of the study because these patients tend to have a less favorable prognosis than younger patients. Eight percent of study subjects were age 60 or older.
All study participants received four cycles of chemotherapy followed by either extended-field or involved-field radiation therapy.
- Overall survival was worse among elderly patients than among younger patients. Five-year survival was 94% among patients under the age of 60 years and 70% among patients age 60 or older.
- Among the elderly patients, survival was worse among those who had received extended-field radiation therapy than among those who had received involved-field radiation therapy. Survival was 59% among elderly patients treated with extended-field radiation therapy, compared to 81% among elderly patients treated with involved-field radiation therapy.
The researchers conclude that extended-field radiation therapy has a negative impact on the survival of elderly patients with early-stage unfavorable Hodgkin’s lymphoma.
Reference: Klimm B, Eich HT, Haverkamp H, et al. Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin’s lymphoma: an analysis from the German Hodgkin Study Group. Annals of Oncology. Early online publication October 27, 2006.