Radiation Therapy After Chemotherapy Can Improve Survival of Patients With Advanced Hodgkin's Lymphoma – ScienceDaily

About 65 to 70% of patients with advanced Hodgkin's lymphoma can be cured by following six cycles of ABVD chemotherapy (including doxorubicin, bleomycin, vinblastine and dacarbazine), with or without subsequent radiotherapy. Currently, however, the addition of radiation therapy is controversial.

In a statement to the conference, Dr. Mario Levis, co-author of the study, Radiation Oncologist at the University of Turin, Italy, explained: "These patients can often have four or five decades of age. However, given this cure rate, cancer treatment can pose a high risk of complications for many survivors, so it is important that we give patients the most effective treatment. to heal their cancer, while, trying to keep the toxic side effects to a minimum. "

To determine whether radiotherapy after chemotherapy ABVD was beneficial for these patients, researchers from several Italian centers, led by Professor Pier Luigi Zinzani, of the Institute of Hematology of the University of Bologna, and Professor Umberto Ricardi, Head of the Department of Oncology at the University of Turin and President of ESTRO, recruited 512 patients between 2008 and 2013 as part of a randomized clinical trial: HD0801 .

Patients who had been successfully treated during Phase II of the trial and for whom PET scans showed no evidence of cancer during and at the end of chemotherapy were randomized to Phase III of the trial. to receive either radiotherapy. in order to mop up the remaining cancer cells or not to continue the treatment.

In total, 354 patients had a PET scan showing that they had no cancer after the initial treatment. Of these, 116 (32.7%) had large lesions (more than 5 cm in diameter) at the time of diagnosis and were badigned to radiotherapy or no treatment.

Dr. Levis and Professor Ricardi found that more patients were alive three and five years later without worsening their disease (called progression-free survival) if they had been treated with radiotherapy compared to those who were not. They had not received one.

Professor Ricardi told the conference: "Three years later, 92% of patients treated with radiotherapy were still alive without progression of the disease, compared with 82% of patients who had not received it. these figures were 89% and 82%, respectively.

This suggests that patients with large tumors, who responded to six rounds of ABVD chemotherapy, could still benefit from the addition of radiation therapy, with survival benefits ranging from 7% to 10% at three and five months. years.

"This is something to consider before deciding whether or not to give radiotherapy to these patients." The omission of radiotherapy would guarantee the prevention of radiation-induced toxic side effects, but in contrast, it exposes 10% of all patients. our patients, often young, of patients at increased risk of relapse and even higher toxicity because of the heavy recovery therapies required upon return of the disease. "

Nine patients enrolled in the radiation therapy group of the trial actually did not receive radiation therapy as a result of a decision made by their doctor and the disease returned in five of them. . This meant that when the data for the 116 patients were badyzed according to "intention to treat" (ie, whether or not they received radiotherapy), there was little difference between both groups in terms of progression-free survival at three and five years. Only when the researchers badyzed the data according to the treatments actually received by the patients ("protocol" badysis) was there a benefit for the survival of the patients treated with radiotherapy, although this was not was not statistically significant. This was mainly due to the low number of patients in whom the disease had returned: five in the radiotherapy group and 13 in the "no further treatment" group of the trial.

"The results of this trial do not provide definitive evidence for the role of radiotherapy after chemotherapy in patients with advanced Hodgkin's lymphoma and large tumors." However, improving the survival of those who The next step is for a meta-badysis of this trial and similar randomized trials to increase the robustness of the information we have on the best way to treat this disease, "concluded Professor Ricardi.

Professor Yolande Lievens, former president of ESTRO and Head of the Department of Radiation Oncology at Ghent University Hospital, said: "As doctors, our main goal is to effectively treat our patients while This is particularly important for patients with a condition such as Hodgkin's lymphoma, many of whom may hope to be cured and live long after the end of their treatment. provide important additional information to consider when advising our patients on what might be the best treatment. "