Newer, more intense chemotherapy with less radiation not more effective against Hodgkin's lymphoma

A lower dose of radiation used to reduce side effects is not as effective as the regular dose when given with the standard chemotherapy in the treatment of Hodgkin's lymphoma patients with early, intermediate-stage disease, according to a first-of-its-kind randomized study presented at the plenary session, November 1, 2010, at the 52nd Annual Meeting of the American Society for Radiation Oncology (ASTRO). In addition, the trial showed that a more intensive chemotherapy (BEACOPP) is not more effective than the standard chemotherapy treatment (ABVD) for these patients.

"This confirms that four cycles of ABVD, followed by 30 Gy involved field radiation therapy, should continue to be the standard treatment for early intermediate-stage Hodgkin's lymphoma patients," Hans Theodor Eich, M.D., Ph.D. lead author of the study and a radiation oncologist at the University of Cologne, in Cologne, Germany, said. "Prior to the study, it was unclear what the optimal chemotherapy regimen and the most effective dose of radiation was."

Chemotherapy followed by radiation treatment is the standard treatment for intermediate-stage Hodgkin's lymphoma. This group of patients has the disease in one or more lymph nodes on the same side of the diaphragm (the muscle under the lungs), along with other factors associated with a higher risk of the cancer spreading to other parts of the body.

Fortunately, cure rates among these Hodgkin's lymphomas, even those considered "unfavorable" as studied here, is very high. That is why doctors continue to experiment with treatment to maximize the chances for a cure while limiting the risks of long-term side effects.

This randomized study sought to determine the most effective dose of radiation for some Hodgkin's lymphoma patients. Researchers also examined whether a more intensive form of chemotherapy would improve the risk of cancer spreading, compared to the standard chemotherapy regime.

Between 1998 and 2003, 1,395 patients with untreated, early unfavorable Hodgkin's lymphoma were randomized into one of four treatment arms: the standard chemotherapy regime and radiation dose, the standard chemotherapy with a lower radiation dose, a more intensive chemotherapy regime with the standard radiation dose and the more intensive chemotherapy with a lower radiation dose.

Results of the study confirm that the standard chemotherapy, ABVD, used with the standard dose of radiation therapy, is the best treatment for patients with early, intermediate-stage Hodgkin's lymphoma. Findings also show that a more intensive chemotherapy, BEACOPP, is not more effective than the standard chemotherapy in treating this group of patients.

Source: American Society for Radiation Oncology