In early stage Hodgkin lymphoma, how effective and safe is long-term treatment when using combined modality treatment including extended or involved field radiotherapy?

FAQ published on March 21, 2014
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Peter Borchmann, MD
Scientific Secretary
German Hodgkin Study Group
Department of Internal Medicine
University Hospital of Cologne
Cologne, Germany
In early stage Hodgkin lymphoma, how effective and safe is long-term treatment when using combined modality treatment including extended or involved field radiotherapy?
Very interesting question and a very important question, and the question is not addressed in clinical trials. When we are talking about long-term sequelae, then we are talking about 10, 20, 30 years, and the trials are stopped at 5 years, so you do not have this information. And then talking about radiotherapy, you have to wait like 20 years if there is an increased risk, for example, for cell tumors which we know it is, but then you have changed the treatment from extended field to involved field to involved node or involved site nowadays, so the technique has improved substantially. So we do not know if the risk we observe today from the treatments 20 years ago will be the same that we will see in 20 years. This is really hard to judge on, for example, in early stage disease with 20-Gray involved-field radiotherapy, I very much doubt that there will be severe side effects and really major increases in the occurrence of second neoplasia, but obviously I don’t know. Nobody knows. So, in the end, I think we should focus on what we know, and we know that it is very well tolerated during the observation period, we have up to 7 to 8 years. It is really very safe. So I would not go for an increase in the aggressiveness of chemotherapy just to omit radiotherapy because this adds toxicity we can see immediately.
Last modified: March 24, 2014
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