Less may be more in the case of treating early stage Hodgkin s lymphoma. While extensive radiation therapy, in conjunction with chemotherapy, was previously considered to be a major advance in disease treatment, new research suggests that adding radiation therapy may actually lower long-term survival for Hodgkin s patients.
Hodgkin s lymphoma is a relatively uncommon type of cancer that affects about 7,500 people in the U.S. each year. Previous research has demonstrated that when patients with early-stage Hodgkin s lymphoma receive radiation therapy plus chemotherapy, their cancer could be controlled effectively, even cured sometimes, with under a 10 percent relapse rate after five years. However, there have been concerns about fatal complications, which arise as much as 10 to 20 years later, that seem to be related to the radiation therapy.
The current study, published in the New England Journal of Medicine, followed over 400 patients with good-prognosis disease (limited extent and non-bulky) over a median of more than 11 years. These patients were randomly assigned to receive either chemotherapy alone or chemotherapy plus limited radiation therapy. The researchers found that the overall rate of survival after 12 years was lower in the group that had received both chemotherapy and radiation (87 percent in this group as compared to 94 percent in the chemotherapy only group). Though both groups had similar rates of death from Hodgkin s disease, patient mortality in the radiation group was significantly higher from other causes, such as second cancers or cardiovascular disease.
There are two important messages from this study, notes ACSH s Dr. Gilbert Ross. One is that too much treatment may do harm in the long run, despite short-term benefits. The other is that for many cancers, you can t just look at the survival rate after three or five years. If a patient with lung cancer is disease-free after five years, he is most likely to be cured. But the same is not true for breast cancer," he says, and this study demonstrates that it is certainly not true for Hodgkin s lymphoma either. Long-term survival rates are more significant.
