Reducing treatment intensity in early-stage favorable Hodgkin lymphoma: is it still effective?

This study aimed to determine whether chemotherapy and radiation doses can be reduced in early-stage favorable Hodgkin lymphoma treatment. This study concluded that fewer chemotherapy cycles and a lower dose of radiation was effective in patients with a good prognosis. 

Radiation was the original standard treatment option for Hodgkin lymphoma. High doses of radiation were associated with the development of second cancers. The addition of the chemotherapy ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) meant radiation doses could be reduced. The current standard treatment for favorable early-stage disease is four cycles of ABVD and 30 Gy (dose measure) of radiation.

These treatments are still associated with long-term side effects. It is not clear whether the chemotherapy or radiation doses can be reduced further while still being effective.

The current study examined the safety and effectiveness of different doses of chemotherapy and radiation in patients with favorable early-stage Hodgkin lymphoma. Patients were randomly assigned to undergo two or four chemotherapy cycles and receive either 20 or 30 Gy of radiation. 1144 patients were included in the chemotherapy comparison: 571 treated with 4 cycles of ABVD and 573 treated with 2 cycles. 1113 patients were included in the radiation comparison: 557 treated with 30 Gy and 556 treated with 20 Gy.

Five-year freedom from treatment failure rates were not significantly different between the treatment groups. Overall survival (time from treatment until death from any cause) and progression-free rates were also not significantly different.

Severe side effects were experienced by 51.7% of patients treated with 4 cycles of ABVD and 33.2% of those treated with 2 cycles. Hair loss was experienced by 28.1% of those in the 4 cycle group and 15.2% in the 2 cycle group. Severe side effects were experienced by 8.7% of those treated with 30 Gy of radiation, compared to 2.9% of those treated with 20 Gy.

Rates of second cancers or death did not significantly differ between the groups.

This study concluded that in patients with favorable early-stage Hodgkin lymphoma two cycles of ABVD followed by 20 Gy of radiation was as effective as the higher doses, with fewer negative effects. 

This study did not examine any complications that occurred more than 5 years after treatment.