PET Scan after Chemo Could Avoid Need for Radiotherapy

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A positron-emission tomography (PET) scan immediately after treatment with chemotherapy can identify patients who have a very good outcome without additional radiotherapy, according to a study published in the New England Journal of Medicine.

The "RAPID" trial involved 602 Hodgkin lymphoma patients who had a PET scan performed after their chemotherapy. Patients who tested positive received radiotherapy. Those who tested negative were split into two groups – one group of 211 patients received no further treatment, while the other group of 209 had the standard radiotherapy.

After three years of regular check-ups, researchers found that the proportion of patients who were alive and free of disease was 94.6 percent in the radiotherapy group, and 90.8 percent in the group that did not receive further treatment.

"The results of RAPID show that in early stage Hodgkin lymphoma radiotherapy after initial chemotherapy marginally reduces the recurrence rate, but this is bought at the expense of exposing to radiation all patients with negative PET findings, most of whom are already cured,” said lead researcher Professor John Radford, who is based at The University of Manchester’s Institute of Cancer Sciences and the Christie NHS Foundation Trust.

The research team notes that a longer follow-up period is needed in order to determine whether this approach will ultimately lead to fewer late side-effects and improved overall survival.

Hodgkin lymphoma is a cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout the body. The current standard treatment is for patients to receive chemotherapy, followed by radiotherapy. However, this radiotherapy comes with undesirable late effects, such as cardiovascular disease and other cancers – despite the fact that they have already been cured of Hodgkin lymphoma.

In the UK, some 1,900 people, many of whom are teenagers and young adults, are diagnosed with the disease every year.

The RAPID study was funded by Leukaemia & Lymphoma Research. Dr. Matt Kaiser, Head of Research at the charity, said: “This groundbreaking clinical trial shows that, by using scans to predict an individual's risk of relapse, many patients can remain disease-free with just chemotherapy alone. Radiotherapy can cause a range of long-term problems like heart disease and hard-to-treat second cancers. As many Hodgkin lymphoma patients are relatively young, it is particularly important to avoid using intensive treatment when it is unnecessary.”

Source: University of Manchester
Image Credit: King's College London

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Radford J, Illidge T, Barrington S et al. (2015) Results of a Trial of PET-Directed Therapy for Early-Stage Hodgkin’s Lymphoma. N Engl J Med 2015; 372:1598-1607 April 23, 2015 DOI: 10.1056/NEJMoa1408648

Published on : Thu, 23 Apr 2015

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Radiotherapy, PET, Chemotherapy, heart disease, Hodgkin lymphoma A positron-emission tomography (PET) scan immediately after treatment with chemotherapy can identify patients who have a very good outcome without addition

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