From the November 15, 2001 issue of the Journal of Clinical Oncology.
Patients with early-stage Hodgkin's disease can greatly benefit from a novel treatment regimen. According to a study by the Southwest Oncology Group, a short course of chemotherapy followed by radiation therapy significantly lengthens the amount of time before patients experience a relapse of their Hodgkin's disease, and minimizes the side effects of treatment.
The 10-year study is the largest randomized trial of early-stage Hodgkin's disease to be conducted in the U.S. in two decades. The purpose of the study was to evaluate whether doxorubicin and vinblastine (two commonly used chemotherapy drugs), followed by radiation therapy, can improve the length of time before patients experience a relapse of Hodgkin's disease, and reduce treatment-related side effects compared with radiation therapy alone (which was the standard of care when the study began in 1991).
The study also determined that staging laparotomy - a previously common abdominal surgery used to diagnose the stage of Hodgkin's disease - could be avoided.
Hodgkin's disease is one of the two basic types of lymphoma, and is a cancer that develops in the lymphatic system, the part of the body's circulatory system that helps fight disease and infection. The disease can start in almost any part of the body including the liver, bone marrow and spleen. Hodgkin's disease is rare, and accounts for only one percent of all cancer cases in the United States.
In the phase III trial, 348 patients were randomized to receive either a combined treatment of three cycles of doxorubicin and vinblastine followed by radiation, or radiation alone. Radiation therapy levels were the same for patients in both groups.
During the three-year follow-up period, 94 percent of patients who received chemotherapy and radiation did not experience a recurrence of their disease or complications from treatment, compared to 81 of patients who received only radiation therapy.
"Patients receiving this novel chemotherapy regimen followed by radiation were much less likely to have recurrent Hodgkin's disease than patients treated with radiation therapy alone," said Oliver Press, M.D., a Professor of Medicine in the Division of Medical Oncology at the University of Washington. "The study also showed that staging laparotomy was not necessary to obtain excellent survival for patients with early-stage Hodgkin's disease."
Only 10 patients experienced a recurrence of their disease in the combined treatment group compared to 34 in the radiation-only group, and only one patient died from treatment-related causes in each group. Because highly toxic chemotherapy drugs were not used, patients generally experienced manageable side effects, including fatigue and mild nausea.
During the last three to four years, combined treatment regimens of short course chemotherapy followed by radiation such as the one used in this trial have become the standard of care for patients with early-stage Hodgkin's disease. Today, nearly all physicians use even smaller radiation fields than were used in this study to keep radiation side effects minimal.
What does this mean for patients?
Patients with early-stage Hodgkin's disease who undergo this treatment regimen are less likely to have recurrent disease, requiring repeated courses of therapy.
The treatment regimen included three cycles of doxorubicin and vinblastine, followed by a four- to six-week rest period before undergoing radiation therapy. Because the chemotherapy regimen only included only drugs with low side effects, the treatment was well-tolerated by the majority of patients. To minimize side effects of treatment, patients should talk to their doctor about receiving a short course of chemotherapy such as doxorubicin and vinblastine, followed by radiation therapy.