Salvage radiotherapy effective in relapsed or refractory Hodgkin’s disease

Salvage radiotherapy improves survival and prevents a second treatment failure in patients with relapsed or refractory Hodgkin’s lymphoma, according to a new report from investigators in Germany.

Patients who relapse after primary chemotherapy for Hodgkin’s disease have a poor prognosis, the authors explain, but salvage radiotherapy may offer hope for patients with localized disease in previously nonirradiated areas.Dr. Andreas Josting from University Hospital Cologne and colleagues investigated the outcomes of 100 patients treated with salvage radiotherapy for progression or relapse of Hodgkin’s lymphoma. The findings are published in the March 1st Journal of Clinical Oncology.More than three quarters (77%) of the patients achieved complete remission after salvage radiotherapy, the authors report. Of these, 68 patients had stage I/II disease, and 9 patients had stage III/IV disease. Another 4 patients achieved partial remission, the report indicates, but 19 patients failed to respond.Actuarial 5-year freedom from second failure was 28% and actuarial 5-year overall survival was 51% after a median observation time of 52 months, the researchers note.In multivariate analyses, Karnofsky performance status significantly predicted freedom from second failure (p = 0.0001), whereas the presence of B symptoms and advanced disease stage at progression or relapse significantly predicted poorer overall survival.Longer duration of first remission also predicted freedom from second failure in patients with limited-stage progression or relapses, the results indicate.”Thus,” the researchers write, “patients with localized disease at the time of progression/relapse without B symptoms seem to be the most suitable candidates for salvage radiotherapy.”Six patients developed pulmonary toxicity, and three patients developed cardiovascular toxicity, the investigators report, but there were no cases of acute myeloid leukemia or myelodysplastic syndrome after salvage radiotherapy.”Incorporating radiotherapy in salvage therapy programs seems to be feasible,” the investigators add, “but the exact efficacy of salvage radiotherapy should be investigated in prospective clinical investigations, using the same selection criteria for all patients with progressive or relapsed Hodgkin’s disease.”(Source: J Clin Oncol 2005;23:1522-1529: Reuters Health: Oncolink: April 2005.)