Progress in quest to reduce use of radiation in treatment of pediatric Hodgkin lymphoma
Cancer returned in 11 patients, including five not initially treated with radiation. The recurrence was successfully treated with chemotherapy and low-dose irradiation. Four patients who received irradiation during their treatment received high-dose chemotherapy and bone marrow transplants when their cancer returned. One patient was successfully treated with a more intensive chemotherapy and radiation combination than the one that initially worked, but that patient did not undergo a bone marrow transplant. Another patient relapsed with a form of lymphoma known as non-Hodgkin lymphoma. Despite treatment, that patient later died of the disease.
Metzger said the findings suggest that for a subgroup of Hodgkin lymphoma patients this therapeutic regimen may not be appropriate. These are patients with nodular lymphocyte predominant Hodgkin. Of the five patients in the chemotherapy-only group who relapsed, four had this subtype.
Radiation Therapy
Radiation therapy was the first curative modality used for Hodgkin lymphoma. However, the doses and fields used for the treatment of adult Hodgkin lymphoma causes profound musculoskeletal retardation, cardiac toxicity, and increased incidence of secondary malignancies in the radiation field (eg, breast cancer in female survivors).
Currently, radiation is used as an adjuvant treatment after chemotherapy. To reduce complications, risk-adapted or response-based, low-dose, involved-field, or extended-field radiation is given. In current trials, the use of nodal conformal radiation is being evaluated to further decrease the burden of radiation to other tissues.
Positron emission tomography (PET) scanning is becoming an important modality to guide involved-field radiation therapy in adult Hodgkin lymphoma, and its role in guiding involved-field radiation therapy in pediatrics is being explored.
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The other authors are Howard Weinstein, Alison Friedmann, Torunn Yock and Nancy Tarbell, all of Massachusetts General Hospital; Melissa Hudson, Scott Howard, Matthew Krasin, Larry Kun, Catherine Billups and Jianrong Wu, all of St. Jude; Amy Billett and Karen Marcus, both of Dana-Farber; Eric Larsen, Maine Medical Center; and Sarah Donaldson and Michael Link, both of Stanford.
The study was funded in part by a Cancer Center Support Grant (CA021765) from the National Cancer Institute at the National Institutes and ALSAC.
St. Jude Children’s Research Hospital
Since opening 50 years ago, St. Jude Children’s Research Hospital has changed the way the world treats childhood cancer and other life-threatening diseases. No family ever pays St. Jude for the care their child receives and, for every child treated here, thousands more have been saved worldwide through St. Jude discoveries. The hospital has played a pivotal role in pushing U.S. pediatric cancer survival rates from 20 to 80 percent overall, and is the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. It is also a leader in the research and treatment of blood disorders and infectious diseases in children. St. Jude was founded by the late entertainer Danny Thomas, who believed that no child should die in the dawn of life.
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Summer Freeman
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St. Jude Children’s Research Hospital