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.
Monika L. Metzger, MD, from St. Jude Children's Research Hospital in Memphis, TN, 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 25.5Gy-involved-field radiotherapy.
The researchers found that the overall two-year event-free survival was 90.8%; the rate was 89.4% in those who did not require radiotherapy, compared with 92.5% 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.