Radiotherapy Plus Chemotherapy Improves Survival in Pediatric Patients With Hodgkin Lymphoma

Pediatric patients with early-stage Hodgkin lymphoma (HL) who are treated with chemotherapy followed by radiotherapy, known as combined modality therapy (CMT), have an improved 5-year survival rate compared with patients treated with chemotherapy alone, according to a study published in JAMA Oncology.

However, there has been a recent decrease in the use of combined modality because both chemotherapy and radiotherapy are associated with an increased risk of toxic effects. Late effects of radiotherapy include cardiopulmonary toxic effects and second malignant neoplasms.

“Nationwide, there has been a notable decrease in combined modality therapy, especially in clinical trials, many of which are designed to avoid this strategy,” Rahul Parikh, MD, a radiation oncologist at Rutgers Cancer Institute and the senior author of the work, said in a statement. “This form of treatment has shown to be effective with event-free survival rates greater than 80% and overall survival rates greater than 95%. The question then becomes, ‘does treatment benefit outweigh the risk of long-term side effects?’”

The study in JAMA Oncology sought to understand the use of CMT in pediatric patients with HL and the associated overall survival. The authors used data from the National Cancer Database and analyzed 5657 pediatric patients 21 years or younger with stage I or II classic HL. Approximately half (50.3%) received CMT.

The authors found male patients were more likely than females to receive CMT. Patients who received CMT were also more likely to be younger, more likely to have stage II disease, and more likely to have private insurance.

A total of 2845 patients received CMT and 2812 patients received chemotherapy alone. Use of CMT was associated with improvement in overall survival (OS). At 5 years, OS was 97.3% for patients receiving CMT and 94.5% for patients receiving chemotherapy alone.

According to Parikh, the findings should encourage physicians to discuss CMT as a treatment option at the time of diagnosis.

“Investigators may also consider designing future clinical trials for this population to include combined modality therapy as a standard arm with the inclusion of interim treatment response assessment (PET [positron emission tomography] scans, etc),” he added. “And as multiple disparities to the use of combined modality therapy have been identified through this work, future studies should address improving access to care for all pediatric patients.”

Reference

Jhawar SR, Rivera-Núñez Z, Drachtman R, Cole PD, Hoppe BS, Parikh RR. Association of combined modality therapy vs chemotherapy alone with overall survival in early-stage pediatric hodgkin lymphoma [published online January 03, 2019]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.5911.