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NCCN Updates Hodgkin’s Disease Treatment Guidelines

NCCN Updates Hodgkin’s Disease Treatment Guidelines

HOLLYWOOD, Florida—There were several significant changes to the
National Comprehensive Cancer Network (NCCN) Hodgkin’s disease guidelines
announced at the Seventh Annual NCCN Conference.

According to Richard T. Hoppe, MD, of Stanford Hospital and Clinics and
chair of the NCCN Hodgkin’s disease panel, the most recent version
excludes laparotomy from the initial evaluation guidelines. Laparotomy had
been in previous guidelines as an option for patients as part of the staging
evaluation. "With respect to the initial staging evaluation of
patients, none of the NCCN institutions [see box] any longer are performing staging
laparotomy and splenectomy," he said.

The new guidelines recommend combined modality therapy for all patients
with early-stage disease. "For the management of patients with
localized disease that is stage I and II, in every scenario, we now indicate
that the preferred treatment is combined modality therapy, which is
generally going to be abbreviated chemotherapy plus involved-field radiation
therapy," Dr. Hoppe said. "There are still yet some scenarios
where we consider radiation therapy alone to be acceptable, but that’s not
necessarily the treatment of choice."

Combined modality therapy had been listed previously as an option, but
this year it was listed as the preferred option. This change, according to
Dr. Hoppe, was based on clinical trials, mainly in Europe, looking at
long-term outcome of treatment with combined modality therapy vs radiation
therapy alone.

"In addition, for early-stage disease, we have mentioned treatment
with chemotherapy alone; however, we advise that chemotherapy alone should
really be done only in the setting of a prospective randomized clinical
trial," he said.

The new guidelines also reflect a deletion of the recommendation of
consolidative radiation therapy for patients with nonbulky stage III or IV
disease. The change is based on a recent European Organization for Research
and Treatment of Cancer (EORTC) trial that was reported last year at the
American Society of Therapeutic Radiation Oncology (ASTRO) and American
Society of Hematology (ASH) annual meetings.

"However, we continue to recommend consolidative radiation therapy
for virtually all stages of disease where there is a large mass, whether it
is early disease or advanced disease," he commented.

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