According to a recent article published in The New England Journal of Medicine, radiation therapy may improve survival for patients who have a partial anti-cancer response following chemotherapy for advanced Hodgkin’s disease. However, radiation does not appear to provide any benefit to patients with advanced Hodgkin’s disease who have a complete disappearance of cancer following chemotherapy.
Hodgkin’s disease 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 cancer that has spread from the site of origin to other distant and/or several sites in the body. Chemotherapy has remained standard treatment for patients with advanced Hodgkin’s disease. The use of radiation therapy, however, has remained controversial for treatment in this group of patients.
Researchers from the European Organization for Research and Treatment of Cancer Lymphoma Group recently conducted a clinical trial to evaluate the effectiveness of radiation therapy in the treatment of advanced Hodgkin’s disease. This trial involved over 700 patients who were initially treated with the commonly used chemotherapy combination referred to as MOPP-ABV ( mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine). Following treatment with chemotherapy, patients were either treated with radiation therapy or no further therapy and were directly compared. In the group of patients receiving radiation therapy, those who had a complete disappearance of detectable cancer (complete remission) following chemotherapy received radiation to sites in the body where cancer had been previously detected and those who had a partial disappearance of cancer (partial remission) following chemotherapy received radiation to the sites where cancer was still detectable. Results indicated that patients achieving a complete remission following chemotherapy do not benefit from radiation therapy, but those achieving a partial remission appear to benefit from radiation therapy following chemotherapy.
Five years following therapy, cancer-free survival in the group of patients who achieved a complete remission following chemotherapy was 84% for those who did not receive radiation, compared to 79% for those who did receive radiation therapy. Overall survival at 5 years for patients who achieved a complete remission was 91% for those not treated with radiation, compared to 85% for those treated with radiation. Conversely, of the patients who achieved a partial remission following chemotherapy, 5-year survival rates were 87% for those treated with radiation, compared to 79% for those not treated with radiation. The development of a second cancer in patients achieving a complete remission following chemotherapy occurred in 4% of patients not treated with radiation, compared to 7.8% of patients treated with radiation. Only 3.2% of all patients achieving a partial remission following chemotherapy developed a second cancer.
The researchers concluded that patients with advanced Hodgkin’s disease who achieve a complete remission following chemotherapy do not benefit from radiation therapy; however, patients who achieve a partial remission following chemotherapy do appear to gain a modest survival benefit from the addition of radiation. The fact that the addition of radiation may increase the chances of development of a second cancer in this group of patients provides further encouragement for utilization of chemotherapy alone as the preferred treatment option in patients with advanced Hodgkin’s who achieve a complete remission following chemotherapy. Patients with advanced Hodgkin’s may wish to discuss the risks and benefits of radiation therapy as part of their treatment regimen.
Reference: Aleman B, Raemaekers J, Tirelli U, et al. Involved-field radiotherapy for advanced Hodgkin’s lymphoma.
The New England Journal of Medicine. 2003;348:2396-2406.