Risk-adapted therapy.
Top Line: Radiation for Hodgkin lymphoma is one-size-fits-all, right?
The Study: Radiation pretty clearly reduces the risk of disease recurrence or progression in patients with early stage Hodgkin lymphoma (HL). Whether that benefit is worth the potential detriments to long-term health (particularly cardiovascular health) is hotly debated. Unfortunately, that debate has largely focused on whether all patients or no patients at all should be treated with RT. The RAPID trial was one of the first to evaluate the omission of radiation therapy based on a negative PET after chemotherapy. After 3 cycles of ABVD and a Deauville 1-2 PET patients were randomized to no further treatment or involved field radiation (IFRT). Those fields encompassed the involved nodal region + 5cm sup/inf and 2cm lateral margins treated with AP/PA fields. Gulp. Three-year PFS was 94.6% with IFRT vs 90.8% without, and it was 97.1% vs 90.8% for those treated per protocol. ]Using individual patient anthracycline dose and cardiovascular radiation dose from treatment plans, this study estimated the 30-year risk of cardiovascular disease (CVD) and CVD mortality, which were compared to baseline CVD risk for the UK population. As you might imagine, CV dose varied widely and was negligible for those with disease outside the neck or mediastinum. Over half of patients had a mean heart dose < 1 Gy and ⅔ had a MHD < 5 Gy. For the entire cohort, the average 30-year risk of CVD mortality was 5.02%, which was composed of baseline risk (3.52%), anthracycline risk (0.94% excess risk), and IFRT risk (0.56%). Just as CV dose varied widely, excess CVD mortality risk from IFRT ranged from 0.01% to 6.79%. Two-thirds of patients had < 0.5% excess CVD mortality risk at 30 years from IFRT. And of note, nearly ⅔ of patients actually had a higher excess CVD mortality risk from anthracyclines than from IFRT. The point is that a majority of HL patients could derive disease benefit from radiation with minimal increase in excess cardiovascular risk.
TBL: Among patients treated with radiation for early stage HL, “the magnitude of [CVD mortality] risk varies widely and, for a majority of patients, the benefit of reduced HL relapse substantially outweighs the risk of CVD.” | Cutter, J Clin Oncol 2021
Thanks to God and also to Dr. OBINA, the great herbal man that cured me from HERPES. I contacted the virus from my partner three years ago, i almost spent all i had because i was restless and i need to get rid of the virus and i did not rest until i saw people testimonies about Dr. OBINA recommendation online for how he has being curing HERPES with his herbs and i emailed him and tell him my problem and he prepare my cure and send it to me and gave me instructions on how to use the herbs and behold after i finish drinking it i went to the hospital for checkup and the result was negative and the virus was completely gone from my body. You can contact Dr. OBINA to get your herbs too and cure yourself from these virus. His Email: obinnaspelltemple@yahoo.com or add him on WhatsApp +19492293867 Dr. OBINA has cure so many different type of diseases with his herbs such as HERPES, HIV/AIDS. CANCER of all kinds, HSV 1&2, DIABETES and so many more. I want to thank God for using Dr. OBINA to cure me from herpes. Dr. OBINA is truly gifted by God. add him on WhatsApp +19492293867
ReplyDelete