Hodgkin's disease patients benefit from radiation therapy
15 Sep 2014
Patients with stage 1 and 2 Hodgkin's Disease who receive consolidated radiation therapy have a higher 10-year survival rate of 84%, compared to 76% for patients who did not receive it.
The data also shows a decrease in the utilization of radiation therapy, according to research presented at the American Society for Radiation Oncology's (ASTRO's) 56th Annual Meeting.
Researchers evaluated clinical features and survival outcomes among 41,502 patients diagnosed with stage 1 and 2 Hodgkin's Disease from 1998 to 2011 from a prospectively collected database -- the National Cancer Data Base (NCDB), which is composed of cases from 1,500 sites and represents >75% of all cancers diagnosed in the U.S. The average patient age was 37 (range: 18 - 90), with a median follow-up of 7.5 years.
Improved overall survival with radiation therapy
Multi-agent chemotherapy was administered to 96% (39,842) of the patients, and 49% (20,441) of patients received a median radiation therapy dose of 30.6 Gy.
The 10-year overall survival of the entire group was 80.8%, with patients receiving radiation therapy having a statistically significant improved overall survival rate at 10 years, when compared to those not receiving radiation therapy. Additionally, the omission of radiation therapy was related to higher rates of salvage transplant procedures performed.
Decreased administration of radiation therapy in practice
Despite this benefit, the utilization of radiation therapy for patients with early-stage Hodgkin's Disease decreased at the study sites from 56% to 41% between 1998 and 2011; and in 88.4% of the patients, the physician-reported reason given for not administering radiation therapy was that it was not part of the planned initial treatment strategy.
The research also indicated that radiation therapy use was associated with younger patients (≤40 years), who are in a higher socioeconomic status, who had access to health insurance, and who received treatment at comprehensive cancer centers
Lead study author: significant improvement shown
"Multiple prospective, randomized trials have shown a significant improvement in disease control with the addition of radiation therapy, however previous trials were limited by low patient numbers and limited follow-up and thus, were unable to demonstrate an overall survival benefit," said lead study author Rahul R. Parikh, MD, a radiation oncologist at Mount Sinai Beth Israel and an Assistant Professor of Radiation Oncology at Icahn School of Medicine at Mount Sinai.
"This is the largest dataset in this patient population to demonstrate a survival benefit with the addition of radiation therapy. Given that the utilization of radiation therapy was associated with younger age, insurance status, higher socioeconomic status, and treatment at comprehensive cancer centers, we have highlighted ongoing disparities in Hodgkin's Disease treatment and it is important that we recognize these findings as potential barriers to care. Given the survival benefit demonstrated in this study, radiotherapy should be included in the combined modality approach of multi-agent chemotherapy followed by consolidation radiation therapy in order to maintain high overall survival rates for this curable disease."
Source: Science Daily