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New Treatment For Lymphoma May Mean Skipping Radiation

Update Date: Apr 11, 2013 02:34 PM EDT

A new type of treatment for young people with a form of lymphoma may mean skipping radiation therapy, avoiding side effects and raised cancer risks later on in life.

The U.S. National Cancer Institute conducted a trial study on patients with primary mediastinal B-cell lymphoma who underwent chemotherapy but not chest radiation, and achieved a full remission.

This type of cancer is typically treated with radiation to the chest, which has been linked to significantly harmful effects in the future, especially for women, according to one of the study's authors.

"These results are exciting and demonstrate that, using this approach, almost all patients appear to be cured and very few patients require radiation," study co-author Dr. Kieron Dunleavy, of the U.S. National Cancer Institute, said in an agency news release.

"This study is a significant achievement in improving the care of a group of lymphoma patients that urgently need it: young patients with an aggressive and -- if left untreated -- rapidly lethal disease," said Dr. Joshua Brody, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City.

Brody was not involved in the study but says it "yielded very exciting success rates with almost all patients going into complete remission even without the use of radiation therapy, which is frequently used for this disease."  All of the patients in the study maintained remission "for a long time," says Brody, "most of the patients are certainly cured of their disease."

Primary mediastinal B-cell lymphoma usually affects people in their teens to early 30s. Researchers pointed out that radiation to the chest area could cause these young patients' damage to the heart as well as increase their risk for other types of cancer, including breast cancer.

While many people today with primary mediastinal B-cell lymphoma are treated with both chemotherapy and radiation do achieve a cure, roughly 20 percent do not, according to an NCI news release.

The trial studied 51 patients who were untreated for primary mediastinal B-cell lymphoma over the course of 14 years. The largest tumor diameter of any patient in the study was 11 centimeters.

Each patient was administered with a regimen which was dose-adjusted EPOCH-R. The regimen included the following drugs: etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and rituximab. Each of the dosages was tailored to the patients to achieve the most effective treatment.

In the study, only two patients who received this dose-adjusted chemotherapy treatment did not go on to achieve complete remission. However researchers noted that these two patients also received radiation and have not had their tumors come back, according to Health Day News.

All of the patients who achieved a complete remission did not experience disease recurrence. The researchers also added there were no signs of heart damage or other long-term negative health effects among the patients.

"The high success of this regimen in greatly reducing the need for radiation and improving the cure rate in this disease may relate to specialized dosing and continuous infusion delivery of the EPOCH-R agents," explained lead researcher Dr. Wyndham Wilson, head of the NCI's Lymphoma Therapeutics Section.

In another study conducted at Stanford University a group of 16 slightly older patients with primary mediastinal B-cell lymphoma were treated with the same EPOCH-R agents. All 16 patients from the study who received the dose-adjusted chemotherapy regimen achieved full remission and none of them required radiation.

"What is encouraging is the fact that so many patients did well without radiotherapy, which will reduce the risk these patients have of developing late complications, including secondary solid tumors, acute leukemia and cardiac disease," said Dr. Jonathan Kolitz, associate chief of hematological oncology at the North Shore-LIJ Cancer Institute in Lake Success, N.Y.

Kolitz also stressed further research needs to be conducted to confirm that the new approach "is truly superior to the more conventional administration" used today.

"It appears that radiation therapy is not required for patients with primary mediastinal B-cell lymphoma who achieve a complete response after treatment with the reported chemotherapy regimen," says Dr. Alan Astrow, director of hematology/medical oncology at Maimonides Cancer Center in New York City. He called the findings "highly impressive results."

"Oncologists go into this business to try to save lives but, truthfully, the opportunity to save the lives of young, healthy people, and give them back a whole lifetime of quality time . . . is particularly gratifying," Brody said.

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