The Case for Chemotherapy Only for Localized Hodgkin Lymphoma

Abstract

Although radiation therapy (RT) alone, and more recently in combination with chemotherapy, has been the cornerstone of curative treatment for early-stage Hodgkin lymphoma for >40 years, the late toxicities of this treatment are increasingly being recognized as causes of significant late morbidity and mortality. In recent years, the focus of treatment of early-stage Hodgkin lymphoma has been reductions in the doses and fields of RT and attempts to reduce the amount and the toxicity of chemotherapy. Another approach has been to treat with chemotherapy alone and to eliminate RT entirely unless it is absolutely necessary. This review summarizes the accumulating information on the late side effects of treatment of Hodgkin lymphoma, the results of trials with chemotherapy only, attempts to reduce the toxicity of chemotherapy, and the new role of positron emission tomography in treatment planning.

Epigenetic mechanisms of plant-derived anticancer drugs

“…In contrast, deacetylation of NF-kB by resveratrol treatment reduced its transcriptional activity in several cancer types (228,230). Elevated NF-κB signaling in cancer cells correlates with chemo-and radio-resistance, so its targeted inhibition by resveratrol may be crucial to resensitize cancer cells to chemotherapy (234). Finally, resveratrol was recently shown to inhibit Metastasisassociated protein 1 (MTA1) and to destabilize the MTA1/HDAC1/p53 complex leading to increased p53 acetylation and activation and, hence, increased expression of p53 target genes, p21 and bax (235).…”

Is Chemotherapy Alone for Early Hodgkin Lymphoma an Emerging Therapeutic Option?

“…It took at least 20 years to appreciate the delayed toxic effects of radiation to the normal tissues included in the radiation fields. These have been enumerated by Dr. Straus [1] and have been the subject of many reviews by cancer centers in North America and Europe. Clearly, the extent of serious complications has shown a continuous rise as a function of time such that 20%-30% of long-term cured patients are succumbing to second neoplasms and cardiac disease attributable to radiation therapy.…”

“…It is very likely that this will reduce some of the toxicity of radiation therapy, but the combination of an anthracycline and irradiation to the cardiac area continues to be a concern. The case for chemotherapy alone as espoused by Dr. Straus [1] involves assessment of relatively small series of patients treated with chemotherapy, usually doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) alone. However, he makes his case clear in that, in carefully monitored trials, there does not appear to be a survival advantage to adding radiotherapy, especially when four to six cycles of ABVD are given and complete remission is achieved.…”