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New Study Looks at Secondary Cancer After Hodgkin's Lymphoma

Every cloud, it is said, has its silver lining: but does every silver lining have its cloud? So it often seems in daily life, and there is no situation so favorable that men are incapable of extracting disaster from it. But medicine is one field in which progress seems almost unalloyed: setbacks are at worst temporary. After all, there had to be antibiotics before there was resistance to antibiotics.

Until the 1960s, Hodgkin’s lymphoma was essentially untreatable and invariably fatal. A combination of radiotherapy and chemotherapy improved the prognosis dramatically to the point of cure, though the treatment was very unpleasant and it gradually emerged that those who survived their Hodgkin’s were more than usually susceptible to developing a second cancer.

By the time a cure became available, medicine had entered the era when anecdotal evidence, until then the mainstay of the science, was no longer deemed sufficient, and it was necessary to prove the effects of treatment, good and bad, more rigorously. This is difficult to do where, as in the case of Hodgkin’s lymphoma, it is a) necessary to follow up patients for a long time, and b) the treatment of the disease changes all the time.

A paper by Dutch researchers in a recent edition of the New England Journal of Medicine tries to answer the question of whether changes in the way in which Hodgkin’s lymphoma is treated – reductions in the dose of radiotherapy and the employment of less toxic anti-cancer drugs – has resulted in a lower incidence of subsequent second cancers. As an accompanying editorial in the journal puts it, "Long-term survival after a diagnosis of Hodgkin’s lymphoma depends on two interrelated factors — successful elimination of disease and the avoidance of treatment-related second cancers." The trick is to eliminate the disease without increasing the chances of a second cancer, and it was assumed that newer treatments did this better than old.