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Cochrane on Optimizing Chemo, Radiotherapy for HL

Cochrane; 2017 Sep 4; Franklin, Eichenauer, et al

Intensified chemotherapy regimens work better in people with Hodgkin lymphoma, though patients face an increased risk of secondary acute myeloid leukemia, according to a Cochrane review of 16 trials involving nearly 3,000 individuals. The trials compared 1) chemotherapy with or without additional radiotherapy; 2) a more extensive or more restricted radiation field; 3) higher or lower radiation dose; 4) more or fewer courses of chemotherapy; and 5) standard-dose or dose-intensified chemotherapy. Among the findings:

  • Chemotherapy without additional radiotherapy was linked with a lower second cancer risk but also possibly more disease growth/regrowth.
  • Second cancer risk, overall survival, and Hodgkin-free survival was similar regardless of the radiation field treated.
  • The same was true when comparing 1) chemotherapy with lower- vs higher-dose radiation and 2) fewer vs more courses of chemotherapy.
  • Dose-intensified chemotherapy improved Hodgkin-free survival, but increased the risk of secondary leukemia.
  • While intensified chemotherapy’s impact on overall survival was not conclusive, escalated-dose BEACOPP seemed to lengthen survival.

Citation:

Franklin J, Eichenauer D, Becker I, Monsef I, Engert A. Optimisation of chemotherapy and radiotherapy for untreated Hodgkin lymphoma patients with respect to second malignant neoplasms, overall and progression-free survival: Individual participant data analysis. Cochrane Database of Systematic Reviews. 2017, Issue 9. Art. No.: CD008814. doi:10.1002/14651858.CD008814.pub2.