Radiation safely omitted after cure of Hodgkin’s disease with chemotherapy

A complete clinical remission of Hodgkin’s disease can sometimes be achieved with chemotherapy alone, allowing children to skip radiation therapy altogether, German physicians reported today at the American Society for Therapeutic Radiology and Oncology’s 46th annual meeting.

Dr. Ursula Ruhl, at Moabit Hospital Berlin, led a seven-nation study in which 1018 children with were treated between 1995 and 2001. The patients were assigned to one of three treatment groups — depending on disease stage, symptoms, and extranodal extension — and were treated with two to six cycles of combination chemotherapy.The 211 patients in whom a complete clinical remission was achieved after chemotherapy alone received no consolidating radiation therapy. Depending on the amount of residual tumor, the remaining patients received 20 to 35 Gy.At median follow-up of 50 months, overall survival was 97%.A total of 916 patients are in continuous complete remission, the investigators reported. There were 38 cases of progressive disease during treatment and 57 relapses after achieving an initial complete tumor control.Disease-free survival for the lowest risk treatment group was 96%. In this group the strategy definitely worked, Dr. Ruhl told Reuters Health. “Quite a number profited because they did not get radiation therapy at all, with all its potential late effects.”For the other two treatment groups, disease-free survival was 92% for those who received adjuvant radiation. The relapse rate was higher for those who did not receive consolidating radiation (69% to 77%). Very few children needed radiation doses as high as 35 Gy, Dr. Ruhl noted, so during the next clinical trial “we can probably cut down the radiation dose” for all but the most advanced cases.”In the next trial we will include biological markers, such as PET scanning, to see if they will help to identify patients who need definitely radiation,” she added.(Source: Reuters Health News: October 2004.)