WEDNESDAY, Aug. 11 (HealthDay News) -- Fewer cycles of
chemotherapy and lower dosages of radiation may work just as well
as more intensive treatment for early-stage Hodgkin's lymphoma, a
new study suggests.
Researchers in Germany randomly assigned 1,370 patients with
early-stage Hodgkin's lymphoma into four groups: four cycles of
chemotherapy followed by either 30 Gy of radiation or 20 Gy of
radiation; or two cycles of chemo followed by 30 Gy of radiation or
20 Gy of radiation.
Gy is the abbreviation for gray, a unit of measurement for
radiation. The chemotherapy was a four-drug combination --
doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) -- the
standard treatment for the disease.
After five years, 91.1 percent of patients in the weakest
treatment group (two cycles of chemo and the lesser dosage of
radiation) had not experienced a relapse, while 93 percent of those
in the strongest treatment group (four cycles of chemo and the
higher dosage of radiation) had, the researchers found.
Though there was a slight difference, the numbers were not
statistically significant, leading researchers to conclude that the
less grueling treatment is just as effective.
"The result is very straightforward: there is more toxicity with the more intensive treatment, and there is less toxicity with the less intensive treatment," said study author Dr. Andreas Engert, a professor of internal medicine, hematology and oncology at the University Hospital of Cologne. "Even the weakest combination of chemotherapy and radiotherapy was as good as the strongest treatment combination in terms of tumor control."
The study is published in the Aug. 12 issue of the
New England Journal of Medicine.
But Dr. Len Lichtenfeld, deputy chief medical officer for the
American Cancer Society, said the findings aren't quite that
straightforward. Although researchers found only a 1.6 percent
difference between the strongest versus the weakest treatment
regimen, the statistical analysis leaves open the possibility that
the difference could have been as large as 6.3 percent.
That means patients should interpret the findings with caution,
Lichtenfeld said, including discussing any changes they want to
make to their treatment regimen with their oncologists first.
Because preliminary findings from this research have already
been reported, many oncologists at major cancer centers may have
already incorporated them into treatment recommendations,
"The authors note that there remains a possibility that there could have been a difference in outcome of about 6 percent, meaning one in 16 patients may have not done well on the less intensive treatment," Lichtenfeld said. "I personally would not make a recommendation to a patient that they should use the least intensive treatment regimen based on these findings."
Hodgkin's lymphoma, which strikes about 8,500 people annually in
the United States, originates in cells called lymphocytes, which
are a part of the immune system, according to the American Cancer
Society. Especially when caught early, it's highly treatable,
Engert said. Among patients in the study, whose average age was 32,
95 percent were still alive after eight years, according to the
The problem is that the chemo and radiation used to treat the
disease can cause both short- and long-term side effects, Engert
Short-term complications include hair loss and infections. Those
side effects occurred less often in those who had the less
intensive treatment compared to the more intensive treatment. For
instance, about 28 percent of those who had four cycles of chemo
lost their hair, compared to 15 percent of those who underwent two
Cancer treatment also has long-term complications. Radiation can
damage the heart, raising the risk of coronary artery disease and
other cancers in survivors decades after the Hodgkin's treatment,
"One of the fallouts of our success treating Hodgkin's lymphoma is that a lot of people are alive now who have other serious medical conditions as a result of their treatment," Lichtenfeld said. "As a result, investigators have been trying to find ways to further tailor therapy to reduce the treatments while maintaining the effectiveness."
American Cancer Society has more on Hodgkin's
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