Using a light hand to treat Hodgkin disease

Children with low-risk Hodgkin disease can be cured using cancer drugs that have only minimal or no toxicity, combined with low doses of radiation, according to St. Jude researchers.

The St. Jude team worked with collaborators from Stanford University Medical Center, Dana-Farber Cancer Institute and Massachusetts General Hospital. The researchers showed that by reducing the intensity of treatment to reflect the low risk of treatment failure, patients retain normal fertility and organ function and are at low risk for developing second cancerous tumors. In fact 17 healthy babies have been born to the study's survivors. A report on these findings appeared in the January 20 issue of Journal of Clinical Oncology.

"We expect to have high cure rates for children with low-risk Hodgkin disease," said the paper's senior author, Melissa Hudson, MD, Cancer Survivorship Division director. "The emphasis is now on minimizing treatment when appropriate to ensure a high quality of life, while maintaining high, event-free survival rates." Event-free survival means that the patient survives and does not experience any serious problems, such as side effects of treatment or recurrence of the disease.

The study of 110 children and adolescents investigated effectiveness of the drug combination of vinblastine, doxorubicin, methotrexate and prednisone and low-dose, involved-field radiation therapy, which is used to treat only the most obvious masses.

The team reported that 99.1 percent of patients with low-risk Hodgkin disease undergoing this treatment can be expected to survive at least five years; 96.1 percent are expected to survive at least 10 years, after which they are considered to be cured. The five-year, event-free survival rate was 92.7 percent, while the 10-year rate was 89.4 percent.

The team identified factors contributing to the high 10-year rate, such as a patient's cancer showing a complete response early during therapy and the presence of fewer than three initial sites of cancer.

The report's other St. Jude authors include Matthew Krasin, MD, Radiological Sciences; Larry Kun, MD Radiological Sciences chair; and Shesh Rai, PhD, Biostatistics.

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