A criticism of the HD.6 trial is that current radiation techniques are probably less toxic than subtotal nodal radiation therapy, which was used in this investigation. Responding to this in an accompanying editorial in The New England Journal of Medicine,1 David J. Straus, MD, of the lymphoma service at Memorial Sloan-Kettering Cancer Center, New York, wrote that studies show a high rate of second cancers and increased deaths due to second cancers and cardiovascular events with radiation therapy of Hodgkin lymphoma.
“It is possible that these complications may still increase long-term mortality despite reductions in the doses and fields of radiation therapy,” he wrote. He also noted that PET-adapted therapy, which is coming into vogue, may actually result in increased volumes of radiation.
Dr. Straus emphasized that radiation is still a useful tool for a subgroup of patients—yet to be defined—where the benefits would outweigh the risks.
“Limiting the use of radiation therapy to the fraction of patients who require it should make an important contribution to the ultimate goal of maximizing the long-term cure rate while minimizing late morbidity and mortality,” Dr. Strauss wrote.
Growing Trend
Speaking at a press conference at the ASH Annual Meeting, Jane N. Winter, MD, Professor of Medicine at the Feinberg School of Medicine, Northwestern University, Chicago, said, “Despite differences in radiation ports and doses between the radiation prescribed in the trial and current strategies, it is likely that the findings will encourage the growing trend in the United States to use chemotherapy alone in early-stage patients. Ongoing trials that do not include radiotherapy are incorporating early PET-scanning [risk-adapted therapy] for early-stage patients and need the support of the [oncology] community to provide additional evidence for this strategy.” ■
Disclosure: Dr. Straus reported no potential conflicts of interest. Dr. Winter was ECOG Chair involved in design of this trial.
Reference
1. Straus DJ: Chemotherapy alone for early-stage Hodgkin’s lymphoma. N Engl J Med. December 11, 2011 (early release online).
The Canadian HD.6 randomized study in patients with nonbulky early-stage Hodgkin lymphoma is mostly of historic interest.1,2 It has little relevance to current treatment standards or questions, and the risk for its inappropriate interpretation is of great concern.