In a nutshell
The purpose of this study was to assess the dose of radiation delivered to organs at risk with modern radiotherapy (RT) in patients with early-stage Hodgkin lymphoma (HL). The authors found that 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and 20Gy of RT for early-stage HL was highly effective and avoided excess doses to organs at risk.
Some background
Early-stage HL can be effectively treated with ABVD chemotherapy. The use of RT as consolidation (treatment meant to kill any cancer cells may be left after initial treatment) HL has resulted in favorable outcomes for patients with HL. RT doses are measured in Gray (Gy). Higher doses of RT can often result in damage to healthy organs surrounding tumors. Currently, the dose of RT required as treatment for HL with reducing the amount of organ damage is unknown.
Methods & findings
42 patients with early-stage HL were treated with RT and ABVD between the years of 2010 and 2019. 86% of patients were treated with 2 cycles of ABVD. RT was delivered with intensity-modulated radiation therapy or volumetric modulated arc therapy. These RT techniques deliver radiation beams from outside the body with high precision to the tumor, with sparing of surrounding healthy tissues. The average follow-up was 44.6 months for this study.
The 3-year survival rate without cancer worsening was 91.2%. The overall survival (OS) rate was 97% at 3 years. Most side effects were mild to moderate and no second cancers occurred until follow-up was complete.
The average dose given to the heart was less than 5 Gy. Among female patients, the average breast dose for both breasts was 0.2 Gy. The total lung dose was less than 5 Gy. Less than 20 Gy were delivered to the thyroid gland and less than 39 Gy to the salivary glands. These are maximum doses which if exceeded, can lead to side effects in these organs.
The bottom line
The authors concluded that 2 cycles of ABVD and 20 Gy of RT for early-stage HL was highly effective and avoided excess doses to organs at risk, which may limit long-term toxic effects.
The fine print
This study had a small population size. Also, all patients came from one medical center and did not include pediatric patients.
Published By :
JAMA network open
Date :
Sep 01, 2020
