Is radiotherapy after chemotherapy associated with late side effects in patients with Hodgkin’s lymphoma?

This study evaluated the long-term outcomes of chemotherapy plus radiotherapy for patients with early-stage classical Hodgkin's lymphoma (cHL). The authors found that this treatment combination was highly effective, with minimal late side effects.

Early-stage (stage 1 to 2) cHL is usually treated with a combination of chemotherapy and radiation. This is called combined modality treatment (CMT). CMT is effective for more than 90% of patients with early cHL. However, CMT is associated with late side effects, such as developing secondary cancer or having cancer come back 10 years or more after treatment.

Lower doses of chemotherapy and radiation can help minimize side effects. However, lower doses can lower the effectiveness of treatment. Balancing the risks of late relapses and late side effects is crucial. The long-term outcomes of CMT for patients with early-stage cHL remain under investigation.

This study had 364 patients with early-stage HL. Patients were treated with two to four rounds of ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine) followed by radiation therapy. Patients were followed for an average of 16 years.

Overall, 98% of all patients were still alive 5 years later. 10 years later, this rate was 96%. Fewer than 1% of patients had the cancer come back (relapse) between 5 and 10 years after treatment. When compared to the general population, only patients whose cancer progressed within 5 years had significantly lower survival. were significantly less likely to survive.

At 5 years, 25 patients had tumor growth or spread (disease progression). At 10 years, this number was slightly higher (26 patients). Overall, 13 patients (48%) had disease progression within 2 years. 2 patients (7%) had disease progression more than 5 years after being diagnosed.

This study concluded that chemotherapy plus radiation is highly effective for patients with early-stage HL, with few late side effects. The authors suggest that patients whose cancer progresses within five years tend to have poorer outcomes.

Some late effects can occur even after 20 years. Also, this study did not consider issues such as preserving fertility. More studies are needed to confirm these results.