Hi. I am Dr. Matt Matasar. Over the next couple of minutes, I am going to be discussing what I see as the pros and cons of radiation therapy in Hodgkin lymphoma.
This is obviously a big subject and a lot more than we can talk about in two minutes, but let me at least outline the issues here for you. Radiation therapy is the single most active treatment that we have in the treatment of Hodgkin lymphoma, but it is also the treatment that is most clearly associated with what we call late effects, meaning problems later in life after patients have been cured. What this means is that you have to be very choosy in who you offer radiation therapy to, and that has to incorporate an understanding of your patient's individual risks of late effects and how their disease control is likely to go with and without radiation therapy. At present, we are very reluctant to use mediastinal radiation therapy in young women who do not have dominant bulk, meaning at least 7 cm in any individual axis, because of the risk primarily of breast cancer in this patient population. We know that women who receive radiation therapy under the age of 30, when they had radiation therapeutic exposure to their breasts, do have an elevated risk of breast cancer later in life. You have to counterbalance the risks of late effects versus the need to use radiation therapy with curative intent in these patients. At Memorial, our approach is increasingly shying away from using radiation therapy in the absence of bulky disease, particularly in younger patients, and reserving radiation therapy for patients who either need it because of bulk or have disease that relapses after definitive chemotherapy alone. Most important is, when you are approaching the question of whether to offer patients combined-modality therapy versus chemotherapy alone, that you weigh the pros and the cons of the need for immediate disease control with radiation therapy versus a consideration of the late effects of that treatment.
Thanks for listening.