title: Combined-modality therapy for early-stage Hodgkin lymphoma: maintaining high cure rates while minimizing risks.
abstract: Multiple randomized studies have demonstrated that chemotherapy, most commonly ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, dacarbazine), followed by consolidation radiation therapy is the most effective treatment program for early-stage Hodgkin lymphoma. With a combined-modality approach, the great majority of patients are cured of their disease. It is also apparent that both chemotherapy and radiation therapy can increase the risk of complications in the decades following treatment, with second cancers and cardiac disease being the most common. Most studies,evaluating such risks primarily include patients treated in decades past with what are now considered outdated approaches, including high-dose, wide-field radiation therapy. The treatment of Hodgkin lymphoma has evolved significantly, particularly in regard to radiation therapy. In combination with chemotherapy, much lower doses and smaller fields are employed, with success equivalent to that achieved using older methods. Many studies have shown a significant decline in both the rates of second cancers and the risk of cardiac disease with low-dose radiation confined to the original extent of disease. In favorable patients, as few as 2 cycles of ABVD have been shown to be effective. The current combined-modality approach seeks to maintain high cure rates but minimize risks by optimizing both chemotherapy and radiation therapy
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA. kelse003@mc.duke.edu
authors: Chris R
authors: CR
authors: Kelsey
authors: Anne W
authors: AW
authors: Beaven
authors: Louis F
authors: LF
authors: Diehl
authors: Leonard R
authors: LR
authors: Prosnitz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D019317:Evidence-Based Medicine; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control; D006689:Hodgkin Disease / Q000473:pathology / Q000628:therapy*; D006801:Humans; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000517:prevention & control; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000517:prevention & control; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome