A short and novel course of chemotherapy followed by radiation significantly slows disease progression and minimizes toxicity in patients with early-stage Hodgkin's disease, reports a study by the Southwest Oncology Group, whose statistical center is at the Hutch.
The largest randomized trial of early-stage Hodgkin's disease conducted in the United States in two decades evaluated whether chemotherapy should be part of treatment for patients with such early-stage disease.
Earlier studies using other chemotherapy combinations followed by radiation also showed better progression-free survival rates, but patients in those studies experienced toxic side-effects.
The SWOG study, published in the Nov. 15 Journal of Clinical Oncology, was led by Dr. Oliver Press of the Clinical Research Division and professor of medicine at the University of Washington. Dr. Michael LeBlanc of the Public Health Sciences Division was a co-author.
The study also found that staging laparotomy, a previously common abdominal surgery used to diagnose the stage of Hodgkin's disease, can be avoided. Instead of undergoing staging laparotomy, patients in the trial were staged clinically, by examining tumor size, lymph node involvement and where the disease had spread.
Hodgkin's disease is a type of cancer affecting the lymphatic system, which includes a network of nodes and vessels that plays an important role in immune response. The disease is common in both early childhood and adults over age 55. The American Cancer Society estimates that in 2001, about 7,400 new cases of Hodgkin's disease will be diagnosed in this country and about 1,300 people will die of the disease
In the 10-year, phase III trial, 348 patients who had not undergone staging laparotomy received radiation alone or a combined treatment of three cycles of the chemotherapeutic agents doxorubicin and vinblastine followed by radiation. Therapy levels were the same for patients in both groups.
Of patients who received the combined treatment, the three-year failure-free survival rate was 94 percent compared to 81 percent of patients who received only radiation therapy. Patients who achieved failure-free survival did not experience a recurrence of their disease or develop other treatment-related complications during the three-year follow-up period. Because of the significant results, the study was stopped at the second interim analysis after nine years.
Ten patients experienced disease progression in the combined treatment group compared to 34 in the radiation-therapy group, and only one treatment-related death occurred in each group. Because highly toxic chemotherapy drugs were not used, patients generally experienced manageable side effects.
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, most physicians use even smaller radiation fields than were used in the study.
- adapted from the Journal of Clinical Oncology