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Ernest H. Rosenbaum, MD
It is estimated that over 75% of Hodgkin's lymphoma patients should expect a long-term survival. Originally, fifty years ago, radiation therapy was the primary treatment. At the ASCO June, 2007 meeting, Yoachim Yahalom proposed concepts to reduce the late morbidity and mortality risks of patients treated for Hodgkin's lymphoma. The complications primarily occur late, often up to thirty years later (many related to radiation therapy and alkylating-agent chemotherapy) to young patients who need to be followed for possible development of a second tumor and/or cardiac disease. Screening is an ongoing process for 20/30+ years for second tumor discovery (breast cancer, lung cancer) and premature heart and coronary artery disease.
Treatments are necessary to cure Hodgkin's disease. The newer and more sophisticated radiation therapy techniques (3-dimensional CAT scans for radiation planning) and newer and safer chemotherapy regimes are the current safer approach.
With the event of the linear accelerator, more exact and safer treatments were developed. With time, the chemotherapy programs have been shown not only to be effective but also have been changed to safer programs that are more efficacious. More recently, the price of success has shown late toxic and sometimes lethal side effects from treatment.
Second malignancies and premature heart disease are the major consequences of therapy. The new goal is to minimize long-term morbidity and at the same time increase the disease-free survival and cure rate. To assess the prognostic factors includes both disease control and risk of late side effects. Most of the problems are from patients treated between twenty to forty years ago. Less radical radiation therapy in combination with newer chemotherapy programs have helped reduce potential toxicities. Studies are now in progress, and thus in upcoming years, better answers will be available.
Also, for those who have failure in disease control, improved salvage programs have become available.
This information was gleaned from the educational book from the 2007 ASCO meeting in Chicago in June. Reviews of articles by:
- Andrea K. Ng, MD, MPH, "Late Effects in Long-Term Survivors of Hodgkin's Disease," pg. 567-570.
Lewis S. Constine and Stephen Lipshultz, "How Cytotoxic Therapy for Hodgkin's Lymphoma Affects Heart Health," pg. 571-577.
Yoachim Yahalom, "Strategies for Reduction of Late Morbidity in Patients with Hodgkin's Lymphoma," pg. 578-583.
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