The treatment of Hodgkin lymphoma has improved dramatically over the last 20 years, with advances in imaging techniques. In the early stages, this cancer of the immune system can be cured with a 95 percent success rate by a combination of radiation and chemotherapy. The major challenge is choosing the dosage to minimize long-term damage from the treatment.
Hodgkin lymphoma has its highest incidence for the age range of 20 to 34 years. Thus, long-term effects of treatment can easily be more deadly than the original disease. Up until the late 1980's, patients received radiation doses high enough to produce serious risks of secondary cancers and heart disease. For patients treated in this era, studies show:
1. Actuarial risk of a solid tumor at 25 years = 21.9 percent
2. Risk of coronary artery disease at 20 years = 10 to 20 percent
3. For women who received thoracic radiation, breast cancer rates at 30 years = 30 percent
4. For nonsmokers or light smokers with thoracic radiation, risk of lung cancer 7 times higher than controls,
5. For heavy smokers with thoracic radiation, risk of lung cancer 20 times higher than controls.
The balancing act of curing the cancer without killing the patient is based on precise determination of the severity of the disease. Classical Hodgkin lymphoma is characterized as follows:
1. Stage I involves a single lymph node; stage I(E) involves one extralymphatic site.
2. Stage II affects two or more lymph node regions on the same side of the diaphragm; stage II(E) includes local extralymphatic extension plus one or more lymph node regions on the same side of the diaphragm.
3. Stage III involves lymph node regions on both sides of the diaphragm; stage III(E) also includes extralymphatic extension.
4. Stage IV includes involvement of one or more organs or sites outside the lymphatic system.
5. Type A disease has no additional symptoms included in type B.
6. Type B includes the presence of at least one of the following: unexplained weight loss > 10% of the baseline weight prior to staging; recurrent unexplained fever > 38 degrees Celsius (100 degrees Fahrenheit); recurrent night sweats.
7. Type X includes a bulky tumor.
For Stages I and II, current treatment options include either chemotherapy alone or combination chemotherapy plus radiation, in doses lower than those used before 1980. There are 785 clinical trials currently in progress to find the optimum treatment for each patient.
References:
Gospodarowicz MK et al, “The management of patients with limited-stage classical Hodgkin lymphoma”, Hematology Am Soc Hematol Educ Program. 2006: 253-8.
Travis LB, “Evaluation of the risk of therapy-associated complications in survivors of Hodgkin lymphoma”, Hematology Am Soc Hematol Educ Program. 2007: 192-6.
Clinical trials:
http://clinicaltrials.gov/ct2/results?term=hodgkin+lymphoma
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.