Progress in quest to reduce use of radiation in treatment of pediatric Hodgkin lymphoma

A multicenter trial showed that nearly half of young patients with early-stage Hodgkin lymphoma can be cured without undergoing either irradiation or intensive chemotherapy that would leave them at risk for second cancers, infertility, heart and other problems later.

St. Jude Children's Research Hospital investigators led this multi-institution study, which focused on pediatric Hodgkin lymphoma patients without widespread disease or symptoms such as weight loss, fever and night sweats. The findings will likely spur efforts to identify patients with even more advanced disease whose cancer could be effectively treated with less irradiation.

"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 Monika Metzger, M.D., an associate member of the St. Jude Department of Oncology. She is the first and corresponding author of the research, which is published in the June 27 edition of the Journal of the American Medical Association.

"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 said. Metzger said the findings point to the possibility that elderly Hodgkin patients with similarly limited disease and who are less able to tolerate intensive chemotherapy may also be candidates for the minimal treatment approach used in this study.

For decades, radiation has been a staple of Hodgkin lymphoma treatment in children and adults. In children, radiation and chemotherapy have helped push long-term survival rates for patients with favorable-risk disease to better than 90 percent. But radiation leaves patients vulnerable to second cancers and other serious problems later. By the 1990s, work was underway in earnest to identify patients who could be cured without radiation.

Hodgkin is found in 850 to 900 children and adolescents each year and accounts for an estimated 6 percent of all childhood cancers. The disease strikes the lymph system, which includes the lymph nodes, tonsils and other immune system components.

Hodgkin disease (Hodgkin's disease) is a highly curable malignancy. Over the past few decades, the understanding and insight into the biology of Hodgkin-Reed-Sternberg (HRS) cells as B-cell derived have led to the classification of Hodgkin disease as a lymphoma or Hodgkin lymphoma.

Hodgkin lymphoma was the first cancer to be cured with radiation therapy alone or with a combination of several chemotherapeutic agents, even before understanding of the biology of Hodgkin lymphoma improved (although its biology is still not fully understood). Since then, the cure rate for children and adolescents with Hodgkin lymphoma has steadily improved, particularly with the introduction of combined radiation and multiagent chemotherapy.