Radiation after chemotherapy may improve outcome for advanced Hodgkin's

NB: The following study was based on observation and was NOT a randomized, controlled trial. Its findings should therefore be taken with a grain of salt.

British researchers funded in part by Cancer Research UK have completed the UK Lymphoma Group LY09 trial and the results suggest that radiation following chemotherapy might reduce the chances of relapse and improve survival in patients with advanced stage Hodgkin's lymphoma (HL).

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COHORT AND METHODS

807 patients randomly assigned between doxorubicin, bleomycin, vinblastine, and dacarbazine and one of two pre-specified multidrug regimens. Between 6-8 cycles of chemotherapy were given, with the higher number going to patients who were showing a slower response. If patients had an incomplete response to chemo or they presented with bulky disease, involved-field radiotherapy (RT) was recommended.

PRIMARY ENDPOINT

Progression-free survival (PFS) as measured from the end of chemotherapy.

RESULTS

"Among 807 patients randomly assigned, 702 achieved objective response.
Post-chemotherapy RT for consolidation was reported in 300 (43%). With median follow-up of 6.9 years, 161 PFS events and 83 deaths were reported."

"Baseline characteristics showed more patients with bulk disease having RT (190 [63%] vs. 111 [28%]) and only partial response after chemotherapy (150 [50%]v 36 [9%]).

"PFS was superior for patients having RT … with 5-year PFS 71% without RT, 86% with RT."

CONCLUSIONS

"Patients who received consolidation RT apparently had better outcomes, consistently across all prognostic groups which persisted in multivariate analysis. This suggests that RT contributes significantly to the cure rate for advanced HL, although patient selection for combined modality treatment requires better definition in prospective trials."

PUBLICATIONS

This study appears in the Journal of Clinical Oncology.

By Ross Bonander

Source: Johnson PWM, et al "Consolidation radiotherapy in patients with advanced Hodgkin's lymphoma: Survival data from the UKLG LY09 randomized controlled trial" J Clin Oncol 2010; DOI: 10.1200/JCO.2009.26.0323.

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