Treatment options for early-stage Hodgkin lymphoma

This study reviewed the treatment options for early-stage Hodgkin lymphoma.

Early-stage Hodgkin lymphoma refers to stages I and II. Early-stage can be further divided into favorable or unfavorable. Patients with unfavorable disease may present with certain risk factors. These include large chest tumors, inflammation (based on blood tests), cancer found in more than 3 or 4 lymph node groups, and cancer found beyond the lymph nodes. Treatment decisions are based on whether the cancer is favorable or unfavorable. 

This article explored the treatment options available for early-stage Hodgkin lymphoma.

Radiation and chemotherapy are the standard treatments for both favorable and unfavorable disease. Combining radiation with chemotherapy allows for smaller areas of the body to receive radiation. On study noted that 88% of patients who underwent both treatments were tumor free after 7 years. In comparison, 67% of those treated with radiation alone were tumor free. Another trial found no difference in outcome in patients who were treated with 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) plus radiation and those who were treated with 4 cycles. Two cycles of ABVD plus radiation is now the standard treatment option for favorable early-stage disease.

In unfavorable disease, 4 cycles of ABVD are generally combined with radiation. A recent study combined 2 cycles of ABVD with 2 cycles of another chemotherapy combination, escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). These chemotherapies combined with radiation increased the time until cancer progression, but did not have an effect on overall survival (time from treatment until death from any cause).

There are a number of side effects associated with treatment. These effects can depend on what area receives radiation. For example, 20 Gy of radiation to the chest area can lead to lung or heart inflammation. Long-term risks of treatment include second cancers and cardiovascular disease.

Current research is examining the use of PET scans to help in determining response to treatment and prognosis. A PET scan uses a radioactive dye to image the organs and tissues of the body. This imaging can highlight areas of cancer involvement. Recent studies show that time without disease progression is high in patients who do not have any visible cancer activity after two cycles of ABVD. These rates are lower for patients who do show visible cancer activity after two cycles. Future research aims to determine whether PET scans can identify patients who can avoid radiation following chemotherapy.

This study concluded that 2 to 4 chemotherapy cycles followed by radiation is the standard treatment option for early-stage Hodgkin lymphoma. This study also concluded that a negative result on an early PET scan may help in deciding whether to omit radiation in patients at high risk of long-term side effects.