Hodgkin’s lymphoma has become one of the success stories of cancer treatment. From 2004-2010, the five-year survival rate was more than 85 percent. Patients often live decades after treatment for Hodgkin’s, but that success puts them in a catch-22 situation: The radiation treatments and chemotherapy that saved their lives may put them at risk for developing second cancers down the road.
Matthew Koshy, MD, is an assistant professor of radiation and cellular oncology at the University of Chicago Medicine who conducts population-based research on the effectiveness of different treatments for cancer. He noted the unfortunate irony of patients facing a second cancer after beating the first.
“The big story about Hodgkin’s is that it’s become a very curable disease in the past 30-40 years,” he said. “But because patients are living much longer now, we see that they’re at increased risk for developing lung cancers or breast cancers, and we think it might be related to the treatment they received.”
Hodgkin’s is a cancer of the immune system that spreads through the lymph nodes. Patients with early-stage disease are usually treated with a combination of radiation and chemotherapy. In the past, physicians used large doses of radiation over broad areas of the body, but in the 1990s, concern over the long-term damage of these treatments led to clinical trials to see if smaller, more targeted doses were just as effective. They were, leading to a widespread shift in treatment in the early 2000s.
While the more focused treatments proved to be just as effective, there had been little research done on whether they were actually reducing the rates of second cancers in survivors. Koshy and his colleagues recently completed the first large, population-based study to look at patients who had been treated for Hodgkin’s during the decade that treatment practices changed, to see if those changes had any effect on long-term toxicity.
The study, published in the journal Cancer Medicine, looked at more than 8,800 patients who received radiation therapy for early-stage (stage I or II), classical Hodgkin’s lymphoma between 1988 and 2009. Of those subjects, 93 percent who were treated between 1988 and 1999, before the shift toward lower doses of radiation, were free from a second cancer after 10 years. After 2000, 95 percent of patients were cancer free 10 years later.
That 2 percent improvement over the second decade is a small, but significant improvement, Koshy said. He believes these results give oncologists more data to justify the push toward treatment regimens that use smaller, more targeted doses of radiation and shorter cycles of chemotherapy to maximize the effectiveness while limiting long-term toxicity.
“It was heartening to see that the changes in treatment technique over the past 20 years have translated into a small, but significant, benefit for patients,” he said.