Study Shows Certain Lymphoma Patients Can Avoid Radiation

Researchers from the National Cancer Institute and Stanford University have found that patients with primary mediastinal B-cell lymphoma can be treated successfully without radiation. This type of cancer starts in the mediastinum, the area in the middle of the chest behind the breastbone. The most common treatment is a chemotherapy combination called CHOP given with the immunotherapy drug Rituxan (rituximab), which often needs to be followed with radiation. Although this leads to a cure in many patients, this treatment isn’t successful at least 20% of the time. Radiation to the chest area can cause serious long-term side effects including lung damage, new cancers, and heart disease.

The 51 patients in the study received a therapy regimen called dose-adjusted EPOCH-R, a combination of several chemotherapy drugs and the immunotherapy drug rituximab. All but 2 of the patients achieved a complete remission with this drug regimen, which means all signs and symptoms of the cancer disappeared in response to treatment. The other 2 achieved a complete remission after receiving radiation. None of the patients had their tumors recur during the study follow-up period of up to 14 years.

The study was published in the April 11, 2013 issue of the New England Journal of Medicine.

Possible long-term side effects

Chest radiation may cause lung damage and lead to trouble breathing. It can also affect the heart, raising the risk of a heart attack later on. It can also increase the risk of lung cancer (especially in smokers) and of breast cancer.

These possible long-term side effects are of particular concern to people with primary mediastinal B-cell lymphoma. About 2 out of 3 people diagnosed with this type of cancer are women. Most are young – in their 30s. Long-term side effects of radiation are of particular concern to young people because the risks of a second cancer related to cancer treatment continue to increase as they get older.

The researchers are now conducting a similar study in children with this type of lymphoma to see if this drug combination can also help them avoid radiation therapy.

“For me, these results are exciting and demonstrate that, using this approach, almost all patients appear to be cured and very few patients require radiation,” said Kieron Dunleavy, MD, first author on the study. “Based on our results, an international phase II trial of dose-adjusted EPOCH-R in pediatric patients with primary mediastinal B-cell lymphoma is ongoing to confirm these findings, and we hope this international trial will have a similarly positive outcome.”

The American Cancer Society medical and editorial content team
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Dose-Adjusted EPOCH-Rituximab Therapy in Primary Mediastinal B-Cell Lymphoma. Published in the April 11, 2013 issue of the New England Journal of Medicine. First author: Kieron Dunleavy, MD, National Cancer Institute, Bethesda, Md.

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