Radiotherapy redundant in low-risk Hodgkin lymphoma treatment

By Helen Albert

Children with low-risk Hodgkin lymphoma who respond well to chemotherapy may not require additional radiotherapy, suggest study results.

If these results are confirmed in future studies, the researchers believe that use of minimal or no radiotherapy in these patients will significantly improve their long-term quality of life.

"This study adds to evidence that it is possible to omit radiation even in patients treated with a less intense chemotherapy regimen and still achieve excellent long-term survival," said lead study author Monika Metzger (University of Tennessee, Memphis, USA) in a press statement.

"These results will help push efforts to further adapt therapies based on a patient's disease risk factors and early response to treatment with the goal of eliminating radiation for as many patients as possible," she added.

As reported in JAMA, Metzger and team compared the 2-year event-free survival rates of 47 children with Hodgkin lymphoma who achieved a complete response after two cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) chemotherapy with those of 41 who had a less than complete response and were given adjuvant radiotherapy (25.5 Gy-involved-field). The mean age of the children on enrollment was 13.9 years.

In the overall cohort, 2-year event-free survival was 90.8%, which met the initial study requirements (90% desired; 80% unacceptably low). When the chemotherapy alone and chemotherapy plus radiotherapy groups were compared, the event-free survival rates at 2 years were 89.4% and 92.5%, respectively.

Adverse events were generally low, with the most common being neuropathic pain (2% patients), nausea or vomiting (3% of patients), neutropenia (32% of cycles), and febrile neutropenia (2% of patients).

Long-term adverse events associated with radiotherapy included asymptomatic compensated hypothyroidism (10% of patients), osteonecrosis and moderate osteopenia (2% of patients for each), subclinical pulmonary dysfunction (14% patients), and asymptomatic left ventricular dysfunction (5% patients).

Editorialists Kimberly Whelan and Frederick Goldman (University of Alabama, Birmingham, USA) comment: "These findings highlight the continued commitment to reduce complications in the treatment of childhood malignancies and add to the growing body of evidence detailing the utility of early response-adapted therapy."

However, they emphasize that "these results must be corroborated in larger, randomized studies because earlier attempts to decrease both the intensity of chemotherapy and to omit radiation in select low-risk patients have not been as promising."

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