Chemotherapy Alone Increases Overall Survival for Early-stage Hodgkin Lymphoma

Ralph M. Meyer, MD

Researchers from the Canadian Cancer Society Research Institute (formerly the National Cancer Institute of Canada) designed a trial comparing 12-year overall survival (OS) between patients who received standard chemotherapy alone and those who received radiation alone.

Approximately 400 patients with stage I through stage IIA Hodgkin Lymphoma were divided into low- and high-risk groups and randomized into 2 treatment arms. One arm received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), while the other received extended-field radiation therapy with or without ABVD.

In 2003, 5-year results of the study were presented at that year's ASH meeting. Those results showed that patients in both groups were performing similarly since receiving their initial therapy.

"That was not surprising given what we knew at the time," said Ralph M. Meyer, MD, director of the NCIC Clinical Trials Group and lead author of the study.

After 12 years, 92% of patients in the ABVD arm had achieved overall survival, compared to 87% of patients who received radiation-based therapy. When analyzing for high-risk patients, results were similar, with 92% of patients in the ABVD arm achieving overall survival after 12 years, compared with 81% of patients in the high-risk group who received radiation therapy.

Meyer reported that there were 12 deaths in the chemotherapy arm and 24 deaths in the radiation arm. In the chemotherapy arm, 6 of the deaths were attributed to Hodgkin Lymphoma, while the other 6 were attributed to other diseases or other cancers. In the radiation arm, 4 deaths were attributed to Hodgkin Lymphoma, but 20 were linked to other diseases. Meyer said this information helps confirm that patients who receive radiation therapy are at a greater risk of developing another cancer or some other disease that puts them at risk for fatal complications.

However, patients treated with radiation therapy had better fibrin/fibrogen degradation products (FFDP) than those in the chemotherapy arm of the study. FFDP are used to measure certain bladder malignancies and could indicate whether or not a person is at risk for developing other forms of cancer.

Meyer said that one of the major limitations of the study was that the form of radiation used in the study is not as targeted as current forms that are used today. He said this is one of the reasons why long-term studies are so hard to perform. These limitations were addressed in greater detail in an editorial accompanying the study, which was published online by the New England Journal of Medicine to coincide with this year's ASH meeting.

While this is a legitimate criticism, Meyer said that the study may cause patients and their treating oncologists to weigh the pros and cons, especially the long-term effects, associated with both forms of therapy.

"It emphasizes the importance of the front-line treatment that is provided," Meyer said.

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