Chemotherapy only in early stage Hodgkin lymphoma: more relapses but the same survival--what to do?
Limited-stage Hodgkin lymphoma can almost always be cured with combined-modality chemotherapy plus involved-field or involved-nodal radiation, at the cost of exposing all patients--many unnecessarily--to radiation. Large prospective randomized clinical trials, including a total of over 1,200 patients, indicate that at least 95% of patients with limited-extent Hodgkin lymphoma are cured. The data also demonstrate that more than 80% of patients treated with two to three cycles of ABVD chemotherapy reach a positron emission tomography (PET)-negative state. Such patients need only one to two additional cycles of ABVD to reach an anticipated 95% cure rate. The remaining 20% of patients, with a positive PET, should be given radiation to reach the same 95% cure rate. The above approach leads to the same overall cure rate as one comprising combined chemotherapy and radiation, but avoids radiation for 80% of patients. Treatment outcome for limited-stage Hodgkin lymphoma is best optimized--considering cost, inconvenience, toxicity, and efficacy--using interim PET assessment to minimize exposure to radiation.
British Columbia Cancer Agency, Centre for Lymphoid Cancer, The University of British Columbia, 600 West Tenth Avenue, Vancouver, BC, V5Z 4E6, Canada, JConnors@bccancer.bc.ca.
Joseph M
JM
Connors
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D003606:Dacarbazine / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D049268:Positron-Emission Tomography; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use
D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin