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Patients with advanced Hodgkin's lymphoma may benefit from post-chemotherapy radiotherapy

Patients with advanced Hodgkin's lymphoma, who have large tumors at the time of diagnosis, may benefit from post-chemotherapy radiotherapy, although all traces of cancer appear to have disappeared, according to recent results presented at ESTRO 38 today (Monday).

Approximately 65-70% of patients with advanced Hodgkin's lymphoma can be cured by six cycles of ABVD chemotherapy (which includes doxorubicin, bleomycin, vinblastine and dacarbazine) with or without radiotherapy. However, the addition of radiotherapy is currently controversial.

Mario Levis, a co-author of a study that is a radiation oncologist at the University of Turin, Italy, explained in a statement before the conference: "These patients can often have four or five decades of life expectancy ahead of them. but given this level of treatment, cancer treatment can lead to a high risk of complications in many long-term survivors, so it is important that we provide patients with the most effective treatment to cure their cancer, while at the same time trying to keep toxic side effects to a minimum.

Research whether radiotherapy after ABVD chemotherapy was beneficial for these patients, scientists at several centers in Italy under Professor Pier Luigi Zinzani of the Institute of Hematology at the University of Bologna and Professor Umberto Ricardi, Director of the Oncology Clinic at the University of Turin and hired 512 patients from 2008 to 2013 into a randomized clinical trial: HD0801.

Patients who were successfully treated at an earlier stage of study II. The phase, and for which PET examinations showed no traces of cancer during and at the end of chemotherapy, were randomized to phase III of the study in which radiotherapy was included. to mop the remaining tumor cells or no further treatment.

A total of 354 patients had PET examinations that showed no cancer after initiation of treatment. Of these, 116 (32.7%) had a large lesion (greater than 5 cm in diameter) at the time of diagnosis and received radiotherapy or no other treatment.

Dr. Levis and Prof. Ricardi found that more patients were alive three and five years later without their disease getting worse (known as progression-free survival) if they were treated with radiotherapy than those who did not.

Professor Ricardi said at the conference: "We found that three years later, 92% of patients who had undergone radiotherapy were still alive without progression, compared with 82% of those who did not. After five years, they were 89% and 82, respectively. % of patients, respectively.

"This suggests that patients with large tumors who have responded to six cycles of ABVD chemotherapy may still benefit from the addition of radiotherapy, with survival benefits ranging from 7% to 10% after three and five years.

"This is something that should be carefully considered when deciding whether or not to give these patients radiation therapy. Omission of radiotherapy would guarantee the prevention of toxic radiation-induced side effects, but on the other hand, 10% of our patients are exposed, often young. patients with increased risk of relapse and even higher toxicity due to severe rescue treatment needed to return the disease.

In fact, nine patients who were enrolled in the radiotherapy arm of the study did not receive radiation therapy due to decisions made by the physician and the disease returned in five of them. This meant that when 116 patient data were analyzed by "intent to treat" (ie, whether or not they actually had radiotherapy), there was little difference between the two groups in progression-free survival in three and five patients. flight. Only after the researchers analyzed the data according to the treatment that patients actually received ("protocol-based analysis"), the survival benefit could be seen in patients treated with radiotherapy, although this was not statistically significant. This was mainly due to the small number of patients who returned the disease: five in the radiotherapy arm and 13 in the "no further treatment" arm.

“The results of this study do not provide definitive evidence for the role of post-chemotherapy radiotherapy in patients with advanced Hodgkin's lymphoma and large tumors. However, improving survival for those undergoing radiotherapy is not negligible. is for the meta-analysis of these and similar randomized trials to increase the robustness of the information we have about the best treatment for this disease, ”concluded prof. Ricardi.

Professor Yolande Lievens, former president of ESTRO and Head of Radiation Oncology at Ghent University Hospital, Belgium, said: “As a physician, our primary goal is to effectively treat our patients while maintaining the side effects of treatment. This is especially important in patients with diseases such as Hodgkin's lymphoma, many of whom may expect to be cured and live long after treatment is stopped. advise our patients on what could be the best treatment. "

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