Patients with early stages of Hodgkin lymphoma should get only chemotherapy to treat the cancer because adding radiation leads to higher death rates, according to a Canadian and U.S. study.
The research, released today by the New England Journal of Medicine and being presented at the American Society of Hematology meeting in San Diego, found that 94 percent of patients getting chemotherapy were alive after 12 years compared with 87 percent of those who got radiation alone or in addition to the drugs.
The findings are good news for patients diagnosed with early Hodgkin lymphoma, a cancer of the lymphatic system, who can skip the more toxic part of a treatment regimen that has been a standard, said Ralph Meyer, the lead study author. Radiation can cause secondary cancers, lead to heart disease and damage cardiac valves years after treatment, the researchers said.
“This really proves the concept that chemotherapy alone in the long term can be a more effective therapy in terms of allowing patients to live longer than treatment that includes radiation,” Meyer, a professor in the Department of Oncology at Queen’s University in Kingston, Ontario, and director of the NCIC Clinical Trials Group, said in a Dec. 9 telephone interview. “Instead of being an option that probably practicing physicians have some degree of discomfort with, I think it now becomes the preferred option.”
The study was funded by the Canadian Cancer Society and the U.S. National Cancer Institute.
Hodgkin lymphoma is one of the most curable forms of cancer, especially if it’s diagnosed early, according to the U.S. National Institutes of Health. More than 90 percent of people with the early forms of the disease will live for at least 10 years.
About 8,830 people will be diagnosed with the cancer in the U.S. and 1,300 will die from the disease this year, according to the cancer institute. The cause isn’t known but it is most common in people ages 15 to 35 and those 50 to 70.
Researchers randomly assigned 405 people with early stage Hodgkin lymphoma to receive chemotherapy or radiation with or without chemotherapy. The patients were followed for up to 12 years.
During the course of the study, 12 patients who received chemotherapy alone died, including six who died of Hodgkin lymphoma, while 24 in the radiation group died, including four who died of the disease. Of those who received chemotherapy alone, four died of a secondary cancer, while 10 in the radiation group died of another cancer, the authors said.
The research also showed that more people in the radiation group had secondary cancers and cardiac events than those getting chemotherapy alone.
The next step is to come up with a better way to identify Hodgkin lymphoma patients who are likely to need radiation beyond chemotherapy to fight their cancer. Meyer estimates that chemotherapy alone will be insufficient for 10 percent to 12 percent of patients with the disease.
Doctors now use radiation that is more targeted to the cancer and less powerful than that used during the study. Still, it’s unclear what those effects will be a decade from now, said David Straus, an attending physician at Memorial Sloan-Kettering Cancer Center and a professor of clinical medicine at Weill Cornell Medical College in New York, who wrote an accompanying editorial in the journal.
Today’s research, he said, is important and helps support doctors who are trying to limit radiation exposure for their patients.
“Radiation therapy was the real breakthrough for early stage Hodgkin’s lymphoma -- that was the first thing that resulted in long-term cures,” he said in a Dec. 9 telephone interview. “Over the last 30-40 years, we’ve been sort of backing away from that.”
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