RESPONSE: Re: Radiation Therapy in the Treatment of Hodgkin’s Disease—Do You See What I See?

Extract

Near the end of “Butch Cassidy and the Sundance Kid,” the heroes, surrounded by the Bolivian cavalry, are about to charge out to meet their fate when Butch asks Sundance, “You didn’t see Lefors out there, did you?” Joe Lefors was the leader of the highly skilled posse that had tracked the two across much of North America. “Lefors? No,” answers Sundance. “Good. For a moment there, I thought we were in trouble.” Butch and Sundance did not accurately assess their risks, overestimating a small risk and underestimating a huge one.

Aleman et al. make two major points. First, radiation therapy may help people who do not achieve a complete response with chemotherapy alone. I agree. The first study to show this benefit was Southwest Oncology Group (SWOG) Study 7808 (1). Second, ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) cannot cure 85% of patients with Hodgkin’s disease. If ABVD alone were as good as MOPP (mechlorethamine, vincristine, procarbazine, prednisone) alone, it would achieve a 92% 10-year survival in early-stage disease (2). The study cited by the authors reports a 5-year survival of 82% in advanced-stage Hodgkin’s disease. If chemotherapy cannot cure 80%–85% of all patients with Hodgkin’s disease, it comes close.