Among patients with early-stage Hodgkin’s lymphoma and a favorable prognosis, it may be possible to reduce the number of chemotherapy cycles and the dose of radiation therapy without adversely affecting outcome. The results of this study were published in the New England Journal of Medicine.
Hodgkin’s lymphoma is a cancer of the lymph system and is diagnosed by the identification of a characteristic cell under the microscope (the Reed-Sternberg cell). 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.
Localized Hodgkin’s lymphoma can be treated with chemotherapy, radiation therapy, or the combination of these approaches. These treatments cure many patients, but the long-term side effects of treatment are an ongoing focus of research. The optimal therapy that cures the most patients with the least side effects is still being determined.
To evaluate treatment with fewer chemotherapy cycles and a reduced dose of radiation therapy, researchers conducted a study among 1370 patients with newly diagnosed Hodgkin’s lymphoma and a favorable prognosis. Patients were assigned to one of four treatment groups:
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- Four cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) followed by 30 Gy of radiation therapy
- Four cycles of ABVD followed by 20 Gy of radiation therapy
- Two cycles of ABVD followed by 30 Gy of radiation therapy
- Two cycles of ABVD followed by 20 Gy of radiation therapy
Freedom from treatment failure and overall survival were similar across treatment groups. Patients who received the most chemotherapy and the highest dose of radiation experienced the highest rate of adverse treatment effects.
These results suggest that treatment with fewer cycles of chemotherapy and a reduced dose of radiation therapy may be as effective as, but less toxic than, more intensive treatment. The researchers caution, however, that the long-term effects of these treatments have not been fully assessed.
Reference: Engert A, Plutschow A, Eich HT et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. New EnglandJournal of Medicine. 2010;363:640-52.
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