No Benefit for Involved Field Radiation in Patients who Hodgkin’s Lymphoma

No Benefit for Involved Field Radiation in Patients who Achieve CR for Stage III-IV Hodgkin’s Lymphoma.

According to results recently published in The Hematology Journal, additional radiation does not appear to improve survival in patients with advanced Hodgkin’s lymphoma who achieve a complete remission following chemotherapy.

1 Hodgkin’s lymphoma is a cancer of the lymph system, which is part of the immune (infection fighting) system that includes blood vessels, bone marrow, lymph nodes and lymph vessels that are present throughout the body. It also includes organs such as the spleen, thymus and tonsils. This cancer is characterized by the presence of the uncontrollable growth and division of atypical white blood cells (immune cells) that crowd lymph tissue, suppressing the formation and function of other cells normally found in this tissue. Advanced Hodgkin’s disease refers to stages III or IV Hodgkin’s in which the cancer has spread from the site of origin to other sites in the body.

Treatment for Hodgkin’s lymphoma depends on the stage of disease, but typically involves chemotherapy, radiation therapy and/or stem cell transplantation. Patients with advanced Hodgkin’s lymphoma who achieve a complete remission (disappearance of cancer) following treatment with chemotherapy are sometimes given further treatment, referred to as consolidation therapy. One type of consolidation therapy is radiation to the sites in which the cancer existed prior to therapy (involved field radiation). French researchers have previously demonstrated that patients with stage III-IV Hodgkin’s lymphoma do not appear to benefit from involved field radiation as consolidation after a chemotherapy induced complete remission.

2 Furthermore, radiation therapy can increase the risk of developing a second cancer.

The European Organization of Research and Treatment of Cancer (EORTC) recently expanded upon this previous trial to evaluate how consolidation therapy with involved field radiation affected outcomes of 736 patients with stages III or IV Hodgkin’s lymphoma. In this trial, patients were divided into two groups: those who achieved a complete remission (CR) and those who achieved a partial remission (PR) following six to eight courses of chemotherapy. Half of the patients in each group received consolidation therapy with involved field radiation and half received no further therapy. Approximately six years following treatment, patients in CR had a cancer-free survival rate of 85% when treated with consolidation radiation compared to 82% when not treated with consolidation therapy. For patients in PR, the cancer-free survival rate was 87% in those treated with consolidation radiation compared to only 78% in those not treated with consolidation therapy. Overall, 6% of patients developed a second cancer. Patients who were treated with radiation had a significantly higher rate of developing secondary cancers compared to patients who were not treated with radiation.

These researchers concluded that consolidation therapy with involved-field radiation does not appear to reduce cancer recurrences or improve survival in patients with advanced Hodgkin’s lymphoma who achieve a CR following chemotherapy. In addition, patients treated with radiation had an increased risk of developing a second cancer. However, for patients achieving only a PR following chemotherapy, additional involved-field radiation therapy seemed to significantly improve cancer-free survival compared to patients who did not receive the additional radiation. Patients with advanced Hodgkin’s lymphoma may wish to speak with their physician about the risks and benefits of consolidation therapy with involved-field radiation or the participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

References:

1.Carde P, Rsemaekers JMM, Aleman B, et al. No Benefit from Involved Field Radiotherapy (IF RT) on Involved Areas in Stage III-IV Hodgkin’s Lymphoma (HL) Patients in Complete Remission after MOPP/ABV (M/A): The EORTC #20884 Randomized Trial. Proceedings of the European Hematology Association. 2002.

The Hematology Journal.2002;3:Abstract number 557.

2.Fermé C, Sebban C, Hennequin C, et al. Comparison of chemotherapy to radiotherapy as consolidation of complete or good partial response after six cycles of chemotherapy for patients with advanced Hodgkin's disease: results of the Groupe d'études des Lymphomes de l'Adulte H89 trial.

Blood. 2000;95: 2246-2252.

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