The use of radiotherapy without chemotherapy may be curative in patients with early stage lymphocyte-predominant Hodgkin’s lymphoma (LPHL), Australian researchers report in the October 15th issue of Cancer.
Dr. Andrew Wirth told Reuters Health, “our data suggest that radiotherapy alone achieves excellent long term remission rates and probable cure for patients with stage I to II LPHL with one to two sites of disease.”The curative potential of such monotherapy has not been defined well. Moreover, concerns about toxicity have led to an interest in minimizing initial treatment, Dr. Wirth of the Peter MacCallum Cancer Centre, East Melbourne and colleagues note.To investigate further, the researchers retrospectively reviewed data on 202 patients. Their median age was 31 years, most were male, 80% had Ann Arbor Stage I disease, 80% had supradiaphragmatic disease and 3% had B symptoms. Thirty-three subjects were lost to follow-up.The most widely used radiotherapy fields were full mantle in 52%, less than a full mantle in 24% of patients and an inverted Y-field in 17%.At 15 years, the overall survival rate was 83% and freedom from progression was seen in 84% of patients with stage I disease and 73% of those with stage II disease. There were no reports of recurrence of LPHL and only one case of non-Hodgkin’s lymphoma. In all, at 15 years, 3% of patients had died from LPHL.Among adverse prognostic factors were being 45 years of age or older, having B symptoms and having an increasing number of involved sites.In light of these findings, “a full mantle field may not be required to maintain excellent freedom from progression,” the researchers note.In fact, continued Dr. Wirth, “these results might be achieved with relatively limited radiotherapy fields, minimizing the long term risks of therapy.””It is uncertain,” he added, “whether combined chemoradiotherapy would substantially improve on the results of radiotherapy alone in this population.”(Source: Cancer 2005;104:1221-1229: Reuters Health: Oncolink: October 2005.)