NEW YORK (Reuters Health), Jun 21 - Patients with advanced Hodgkin's lymphoma who receive radiotherapy following chemotherapy appear to do better than those who don't, U.K. researchers report in a May 24 online paper in the Journal of Clinical Oncology.
While this finding didn't come from a random allocation scheme, it still shows "that we need to be cautious about the recent trend to avoid radiotherapy" in patients with Hodgkin's lymphoma, lead author Dr. Peter W. M. Johnson told Reuters Health by e-mail.
Dr. Johnson of the University of Southampton and colleagues base their conclusion on data from a trial in which patients were randomly assigned between doxorubicin, bleomycin, vinblastine, and dacarbazine and one of two prespecified multidrug regimens.
Involved-field radiotherapy was recommended for patients who had an incomplete response to chemotherapy or bulk disease at presentation. Out of 702 with an objective response, 300 had radiotherapy for consolidation.
The majority of those who had radiotherapy (190) had initial bulk disease. Fifty percent had only a partial response to chemotherapy, compared to a 36% partial response rate in nonradiotherapy patients. More nonradiotherapy patients were reported as being in complete remission.
To the authors' surprise, however, progression-free survival was superior in the radiotherapy group -- despite the fact that these patients had "apparently adverse characteristics, with more bulk at the start and more residual abnormalities at the end of chemotherapy," they say.
At a median of 6.5 years of follow-up, the radiotherapy group had a hazard ratio of 0.43 for progression-free survival. At five years, progression free survival was 86% versus 71%, and there was a similar advantage for overall survival (hazard ratio, 0.47).
"Oncologists are keen to avert possible side effects from radiation," Dr. Johnson concluded, "but we need to be aware that this can be an important part of effective treatment."
By David Douglas
http://jco.ascopubs.org/cgi/content/abstract/JCO.2009.26.0323v1
J Clin Oncol 2010.
Last Updated: 2010-06-18 16:31:30 -0400 (Reuters Health)
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