HOLLYWOOD, FloridaThere 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.