Radiotherapy with chemotherapy improves survival in young Hodgkin lymphoma patients

Radiotherapy combined with chemotherapy resulted in better five-year survival in patients with early-stage pediatric Hodgkin lymphoma (HL) than chemotherapy alone, reported authors of a Jan. 3 study published in JAMA Oncology.

The authors analyzed more than 5,500 pediatric patients with either stage I or II HL from January 1, 2004 to December 31, 2015, taken from the National Cancer Database. For patients who received combined modality therapy (CMT) the five-year overall survival (OS) was 97 percent, compared to the 94.5 percent achieved in those treated solely with chemotherapy.

The results are similar to the survival benefit achieved in adults diagnosed with traditional HL and treated with CMT, added lead author Sachin. R. Jhawar, MD, of Rutgers Cancer Institute of New Jersey in New Brunswick, New Jersey, and colleagues.

Additionally, the youngest patients (1-13 years) received the least benefit from CMT, which is important because they also are most vulnerable to the negative effects of radiotherapy, the authors wrote.

Jhawar et al. found worse five-year outcomes in black patients compared to whites and determined CMT most beneficial in younger, male patients with stage II disease who also held private insurance.

During the analysis period, the group found a nearly 25 percent decrease in the use of CMT. In more than 90 percent of cases physicians reported they did not administer radiotherapy as part of the CMT program because it was not included in the planned initial strategy. However, Jhawar noted there is only very limited data in “highly selected” patient groups suggesting chemo alone as the appropriate treatment pathway.

While there were some limitations to the study, including its retrospective design, Jhawar et al. suggested radiotherapy be considered in CMT going forward.

“This study’s findings suggest that, compared with chemotherapy alone, the use of CMT for pediatric patients with early-stage HL (particularly adolescents and young adults) is associated with an improvement in OS at 5 years in the largest data set reported to date,” the authors concluded. “We suggest that consolidation radiotherapy as part of CMT may be considered in future clinical trials for patients with early-stage disease.”