NCCN Updates Hodgkin’s Disease Treatment Guidelines

HOLLYWOOD, Florida-There were several significant changesto the National Comprehensive CancerNetwork (NCCN) Hodgkin's diseaseguidelines announced at the SeventhAnnual NCCN Conference (seeTable for NCCN member institutions).According to Richard T. Hoppe,MD, of Stanford Hospital and Clinicsand chair of the NCCN Hodgkin'sdisease panel, the most recent versionexcludes laparotomy from theinitial evaluation guidelines. Laparotomyhad been in previous guidelinesas an option for patients as partof the staging evaluation. "With respectto the initial staging evaluationof patients, none of the NCCN institutionsany longer are performingstaging laparotomy and splenectomy,"he said.The new guidelines recommendcombined modality therapy for allpatients with early-stage disease."For the management of patientswith localized disease that is stage Iand II, in every scenario, we nowindicate that the preferred treatmentis combined modality therapy,which is generally going to be abbreviatedchemotherapy plus involved-field radiation therapy," Dr.Hoppe said. "There are still yet somescenarios where we consider radiationtherapy alone to be acceptable,but that's not necessarily the treatmentof choice."Combined modality therapy hadbeen listed previously as an option,but this year it was listed as the preferredoption. This change, accordingto Dr. Hoppe, was based on clinicaltrials, mainly in Europe, lookingat long-term outcome of treatmentwith combined modality therapy vsradiation therapy alone."In addition, for early-stage dis-ease, we have mentioned treatmentwith chemotherapy alone; however,we advise that chemotherapy aloneshould really be done only in thesetting of a prospective randomizedclinical trial," he said.The new guidelines also reflect adeletion of the recommendation ofconsolidative radiation therapy forpatients with nonbulky stage III orIV disease. The change is based on arecent European Organization forResearch and Treatment of Cancer(EORTC) trial that was reported lastyear at the American Society of TherapeuticRadiation Oncology(ASTRO) and American Society ofHematology (ASH) annual meetings.National Comprehensive Cancer Network
Member Institutions
The Arthur G. James Cancer Hospital &Richard J. Solove Research Institute atOhio State University, Columbus
City of Hope Cancer Center,Los Angeles
Dana-Farber Cancer Institute, Boston
Duke Comprehensive Cancer Center,Durham, North Carolina
Fox Chase Cancer Center, Philadelphia
Fred HutchinsonCancer Research Center, Seattle
H. Lee Moffitt Cancer Center &Research Institute at the Universityof South Florida, Tampa
Huntsman Cancer Institute at theUniversity of Utah, Salt Lake City
The Sidney Kimmel ComprehensiveCancer Center at Johns Hopkins,Baltimore
Memorial Sloan-KetteringCancer Center, New York
Robert H. Lurie ComprehensiveCancer Center of NorthwesternUniversity, Chicago
Roswell Park Cancer Institute,Buffalo
St. Jude Children'sResearch Hospital, Memphis
Stanford Hospital andClinics, Stanford
University of Alabama atBirmingham ComprehensiveCancer Center, Birmingham
UCSF ComprehensiveCancer Center, San Francisco
University of Michigan ComprehensiveCancer Center, Ann Arbor
UNMC/Eppley Cancer Center at theUniversity of NebraskaMedical Center, Omaha
The University of Texas M.D.Anderson Cancer Center, Houston"However, we continue to recommendconsolidative radiationtherapy for virtually all stages of diseasewhere there is a large mass,whether it is early disease or advanceddisease," he commented.Dr. Hoppe and his co-presenter,Jane N. Winter, MD, of the RobertH. Lurie Comprehensive CancerCenter of Northwestern University,made a strong point to encourageUnited States clinicians to enter patientsinto Hodgkin's disease clinicaltrials.Currently in the United States,there is a trial for advanced diseasecomparing conventional treatmentwith ABVD (doxorubicin,bleomycin, vinblastine, anddacarbazine) to treatment withStanford V (doxorubicin, vinblastine,mechlorethamine, vincristine,bleomycin, etoposide, and prednisone)chemotherapy. This alwaysincludes consolidative radiationtherapy to bulky sites of disease, definedas greater than 5 cm, Dr.Hoppe said.Large cooperative group trials inEurope are looking at issues relatedto the management of early disease."Those are important-they are testingthe question of how many cyclesof chemotherapy are appropriate andwhat dose of radiation is necessaryfor patients with stage IA or IIA disease.Those trials have variations inthe numbers of cycles of chemotherapy,from 2 to 4 to even 6, and in thedose of radiation from 20 Gy to 30Gy and 36 Gy," Dr. Hoppe said.In addition, he said, there are trialsin Europe and North Americatesting the concept of chemotherapyalone for patients with early-stagedisease, "and we encourage participationin those trials."