Limited radiation acceptable in pediatric Hodgkin's lymphoma
Limited Radiation Acceptable in Pediatric Hodgkin's Lymphoma
(HealthDay News) -- For patients with favorable-risk Hodgkin's lymphoma who achieve a complete early response to chemotherapy with vinblastine, Adriamycin (doxorubicin), methotrexate, and prednisone (VAMP), two-year event-free survival rates are high with limited use of radiotherapy, according to a study published in the June 27 issue of the Journal of the American Medical Association.
Monika L. Metzger, M.D., from St. Jude Children's Research Hospital in Memphis, Tenn., and colleagues conducted a multi-institutional, phase 2 clinical trial to evaluate the need for radiotherapy based on early response to chemotherapy for 88 eligible patients with stage I and II Hodgkin's lymphoma. No radiotherapy was received by 47 patients who achieved a complete response after two cycles of VAMP, while 41 patients with less than a complete response received 25.5 Gy-involved-field radiotherapy.
The researchers found that the overall two-year event-free survival was 90.8 percent; the rate was 89.4 percent in those who did not require radiotherapy, compared with 92.5 percent in those who were treated with radiotherapy (P = 0.61). Neuropathic pain, nausea or vomiting, neutropenia, and febrile neutropenia were the most common acute adverse events. There were 11 hospitalizations for febrile neutropenia or non-neutropenic infection in nine patients. Asymptomatic compensated hypothyroidism; osteonecrosis and moderate osteopenia; subclinical pulmonary dysfunction; and asymptomatic left ventricular dysfunction were long-term adverse effects after radiotherapy. There were no secondary malignant neoplasms among the cohort.
"Our results suggest that a risk-adapted response-based approach may be very effective and well tolerated for a selected group of patients with favorable-risk Hodgkin lymphoma," the authors write.
Two authors disclosed financial ties to the pharmaceutical and biotechnology industries.