Hodgkin's Disease - Other Treatments

In general, these serious late side effects are dependent on the cumulative drug dose and rate of administration.

Combinations of Chemotherapy and Radiation (Combined Modality)

Regimens. Chemotherapy (usually ABVD) plus radiation, referred to as combined modality, is a common treatment approach for patients with more advanced-stage disease and for those who have early-stage bulky (large mass) disease.

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In a 2000 study, the Stanford V regimen combined with radiation produced excellent survival and remission rates among patients with early-stage bulky and with stage III/IV disease. A comparison study with ABVD is under way. Studies indicate that lower amounts of radiation may be suitable for treating early-stage HD. In a 2005 study, doctors cut in half the dose of radiation typically used with chemotherapy, and 98% of patients treated achieved remission. Some studies suggest that radiation adds no additional advantages for patients with advanced HD who show no signs of disease after initial chemotherapy. It also significantly increases the risk for secondary cancers compared to chemotherapy alone.

Chemotherapy with low-dose radiation is being used in children with excellent results, even for late stage cancer. In one study, 82% of the children were still disease free at5 years. Some chemotherapy drugs or high doses of radiation may be more deleterious to a boy's future fertility than to a girl's. A gender-specific combined regimen for pediatric Hodgkin's reduces the amount of radiation given to boys and also substitutes etoposide for procarbazine in the chemotherapy mixture (procarbazine, vincristine, prednisone, and doxorubicin).

Side Effects and Long-Term Complications. Side effects of combination treatments can be very serious. They not include the adverse effects of the individual treatments but some may be compounded. Examples include the following:

Combined modality poses a higher risk for secondary cancers than the use or radiation or chemotherapy alone. They, include breast, lung, thyroid, melanoma, and gastrointestinal cancers, which usually develop in near or in the areas treated with radiation. Of note, the risk for breast cancer is lower when chemotherapies using alkylated drugs or radiation treatments damage the ovaries, suggesting that hormone stimulation plays a role in this higher risk. Newer drugs used in combined modalities may reduce the risk, at least for breast cancer.
ABVD and other regimens containing bleomycin increase the risk for severe effects on the lungs when used before or after mantle-field radiation. EVA (etoposide, vinblastine, and doxorubicin) is considered to be an effective substitute in patients with lung disease for whom bleomycin and radiation present an unacceptable risk.