Here's an example of progress in cancer treatment: a trial that produced long-term survival rates better than 90%, and that is described as outmoded because it's been replaced by treatments that get even better results with fewer side effects.

The cancer is Hodgkin's disease, a type of lymphoma, or cancer of lymph tissue found in the lymph nodes, spleen, liver and bone marrow. And the new findings come from a European group led by French physicians. They are reporting five-year, disease-free survival as high as 98% for patients with the most favourable prognosis and in the mid-80s or better for those who showed up with a worse outlook. The results are published in the November 8 issue of the New England Journal of Medicine.

It's not an easy paper for a layperson to read, because it is full of acronyms for the combination chemotherapy that was used (MOPP-ABV) and different cycles of radiation therapy. The study conclusion is that this "should be the standard treatment for Hodgkin's disease with favourable prognostic features."

But then there's the accompanying editorial by Dr Volker Diehl of the University of Cologne, in Germany, which says that these results have been overtaken by time and better treatments. MOPP-ABV now has been replaced by a different chemotherapy regimen, called ABVD, Diehl said, with even better survival rates. And research now is centred on such issues as possible reductions in radiation therapy, he said.

The standard procedure for people with early-stage Hodgkin's disease is to classify them as "higher" or "lower" risk on the basis of such things as age, symptoms and spread into lymph nodes, said Dr Mitchell Smith, director of lymphoma service at the Fox Chase Cancer Center in Philadelphia. About two-thirds of Hodgkin's cases are early stage. Those diagnosed in later stages get the same basic treatment, but more of it - radiation plus cycles of ABVD chemotherapy. It has replaced MOPP-ABV because it causes fewer side effects, such as problems with sterility, Smith said.
"In a favourable group, you get close to 95% five-year survival with the right treatment," Smith said. "In the unfavourable group, it is close to 80%. Very few people relapse after five years."

The new approach is close monitoring of patients' condition during treatment to determine how much radiation therapy is needed - not so much the amount but how large an area of the body should be irradiated. There is a hope that chemotherapy alone can cure some patients, Diehl's editorial said.

"Dr Diehl and the German group are doing among the best Hodgkin work now," said Dr Bart Kamen, chief medical officer of the Leukemia and Lymphoma Society. "It is an editorial right on the mark as far as I am concerned."

And Smith does not shy away from saying "cure," a word long shunned in cancer treatment. With a 95% disease-free rate after five years and few relapses after that, why not use the word when dealing with Hodgkin's disease, he asked. "Most people will be comfortable with cure in five to 10 years," Smith said.

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Originally posted November 2007.

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