Efficacy and safety of the
conventional treatment for Hodgkin's: behind the hype
Is Hodgkin's lymphoma in children as highly "curable" with the
conventional chemo and radiation treatment as the headlines in
various medical and media publications would make you think? After
going through a small but relevant portion of evidence, it turned
out not to be the whole truth.
And, mind you, what's been left out
doesn't exactly support proclaiming official treatments for
Hodgkin's a cure.
What makes it to the headlines is usually the success rate with
early-stage, low- to mid-risk childhood Hodgkin's patients within 5
years, occasionally 10-years from commencing the treatment. That
probably seems to be a nice thing to put in the headline, or write
So, what should we make of a headline such as "Doctors report
high survival rates for Hodgkin's disease", with 98% 5-year
symptom-free survival rate for Hodgkin's patients on conventional
treatment with most favorable prognosis, and at least 85% for those
with worse outlook cited in the text? Adding that it's been already
surpassed by more effective and safer chemo/radiation
Sounds as if conventional medicine has gotten for us
a real cure for Hodgkin's,
But when you take a closer look of this particular study (Fermé
et al, Chemotherapy plus
Involved-Field Radiation in Early-Stage Hodgkins Disease,
2007), you find out it was, as its title says, limited to early,
easier to treat
stage Hodgkin's (I and II), but that nevertheless used rather intensive
treatment of MOPP-ABV chemo plus 36-44 Gy involved field radiation.
If the study had advanced Hodgkin's disease (III and IV) cases included, the low percentage
would be, as usual, somewhere around 70%. Not good enough for the
Remember, also, that "symptom-free" relates to the specific
symptoms of Hodgkin's; it doesn't account for other symptoms of
compromised health and feeling of wellbeing caused by the harsh,
This news is, actually, no news. It is known for quite some time that intense chemo/radiation treatment
can result in higher overall and "symptom-free" survival rates in
Hodgkin's patients in the first 5 to 10 years. The earlier, more
favorable stage the higher rate, sometimes approaching 100%. The drawback is that
higher toxicity takes higher toll in
mortality rates after this period.
And, as the
long-term mortality plots show, this toll is too high, not in a
small part due to those practicing the treatment being lured into
favoring more intensive protocols by their higher early "success
For instance, the National Cancer Institute web site cites the
study that had established 3.2 times higher risk of developing breast
cancer (period not specified) for women treated with 4 Gy of
radiation and 8-fold increase for those exposed to 40 Gy (Travis et
al, Breast cancer
following radiotherapy and chemotherapy among young women with
Hodgkin disease, 2003). But the study was for women
diagnosed at the age of 30 or younger.
What NCI page doesn't mention is
that the risk increases significantly for females younger than 20 -
as mentioned, as much as 56 times for women treated at 16 years of age or
younger, within averaged 17-year period from the treatment (Late
Effects Study Group).
In fact, trials claiming near 100% survival rate within first 5
years, or so, from the treatment, have been around for the past 2-3
decades. The shiny facade of conventional medicine that these
every-once-in-a-while studies proudly display is that its highly toxic chemotherapy/radiation treatments
can be very effective in killing Hodgkin's malignancy. What gives
much less of a reason to be proud of and is, for that reason, either
left out or usually mentioned only in more or less general terms, is that
cardiac, pulmonary, liver, and overall cellular toxicity of such
taking heavy toll on
Hodgkin's patient population down the road.
Especially the children. What was unfolding for the past few decades in this field - and
still continues as we speak - is a long, slow process in which the conventional
medicine attempts to reduce this toll by modifying these toxic treatments
so that their suspected most damaging "ingredients" are
minimized or, if possible, replaced by other toxins that haven't
gotten a "bad jacket" yet.
So the last 2-3 decades have
been spent in chasing that particular combination of toxic chemical
and radiation that would maximize remission rate for different
stages of Hodgkin's, while at the same time minimizing relapse rate
and long-term treatment-related morbidity and mortality.
The list of what they have learned so far is rather long. Excessive
toxicity is, so far, associated with:
extended field radiation,
intense involved (limited) field radiation, both linked to vastly
increased risk of developing secondary solid tumors, sterility,
cognitive impairment, cardiac disease, pulmonary fibrosis, spinal
deformities, skin cancer, etc.
(heart disease, bone marrow suppression - leukemia)
(hypogonadism, sterility, leukemia, bladder disorders/cancer, bone
cancer, pulmonary fibrosis, kidney damage, cataract)
(seizures, cognitive impairment, bone marrow suppression, liver
(liver cirrhosis, neuropathy)
epipodyphyllotoxin (leukemia, secondary malignancy)
prednisone and other corticosteroids (osteopenia, osteoporosis,
combinations like chest radiation and bleomycin,
chest radiation and
radiation and alkylating agents,
chest radiation and abdominal or pelvic irradiation,
topoisomerase 2 inhibitors
(bone marrow suppression, acute myeloid leukemia, myelodysplastic
and so on.
The early chemo
modality standard MOPP, leaving nearly all male patients sterile
(also leaving most female patients with ovarian failure - early menopause) and
causing excessive incidence of leukemia (among other diseases), has been improved upon by
the ABVD modality, more forgiving fertility- and leukemia-wise, but
with elevated cardiac and pulmonary toxicity.
The problem is that significant reduction in treatment's toxicity
also reduces its
efficacy against Hodgkin's, to the extent that some trials in that
direction had to be discontinued.
The simple, obvious truth is that this type of treatment has to
be sufficiently toxic in order to kill cancer cells. And that
there is no way to protect rest of the body from its toxicity.
Just take a look at the mechanism of action of some common
◊ alkylating agents (some of which are used as
chemical weapons, and handled wearing personal protective gear) -
damaging DNA by adding to it alkyl group, which causes denaturation
of DNA molecules, formation of adducts (damaging stable molecular
bonds/cross-linking) and overall alteration of the DNA structure;
alkylated DNA becomes dysfunctional, degrading cellular viability,
or causing cellular death; it can, of course, also produce mutated,
possibly malignant cells
◊ BLEOMICIN - splitting DNA strands
◊ PLANT ALKALOIDS - mitosis (cellular division) disruption
◊ EPIPODYPHYLLOTOXIN (VP-16) - interfering with
cell cycle progression
◊ ANTIMETABOLITES (methotrexate, 6-mercaptopurine)
- inhibition of nucleotide synthesis
◊ ASPARAGINASE - inhibition of protein synthesis
Although, in general, chemotherapy agents should be hurting
cancer cells more, the treatment has no mechanism to efficiently
prevent damage to normal cells by their toxicity.
conventional medicine got stuck with a highly toxic treatments for
cancer in general and Hodgkin's lymphoma in particular, which it
desperately attempts to repackage and resell it as a "cure".
Because it is a multibillion dollar business, and it is their "tardemark".
sense tells us that this repackaging is not likely to bring significant changes. Since the
combined radiation/chemo modality treatment that begun with the MOPP+radiation back in
mid 1960s, and advanced to still the "gold
standard" ABVD+radiation in 1975, most of the reduction in
treatment toxicity has been achieved by reducing the radiation
exposure. But there is nowhere to go from where it is now. So called
mixed modality treatments that juggle different toxic ingredient, as
long as they are effective in poisoning the Hodgkin's, are
bound to be as toxic
long-term as the standard modalities.
Such treatment can never become a cure. Even the word "success" can
be applied only conditionally, when measured against the "no
treatment" option. No other treatment option has been given a fair
chance to compete. If 2 out of 3 of your children patients are likely
to die within the next three decades, and nearly all will suffer
from chronic diseases, your treatment is NOT successful. It is NOT a
Hinting that this may be due to the long-term consequences of unnamed
factors related to the Hodgkin's disease pathology does not sound
very convincing. Toxicity does.
Toxins can be safely used against cancer only if they can be for
the most part channeled to the cancerous cells, the way that, for
instance, the ingenious Dr. Whelan's
Photodynamic Therapy does. Or
the way that the alternative,
cancer-cell-killers like laetrile or cesium do. The other venue to
explore is, of course, what is it in the body that leads to Hodgkin's disease, and address its causes directly.
All this brings us back to the original question: Does the
government has the right to force children to undergo conventional
Hodgkin's treatment against their own and their parents' will?
Should your oncologist be allowed to take you to the court because
you want to try non-invasive treatment first?
Our little research shows that the toxic, invasive conventional
treatment is efficient in eliminating Hodgkin's and keeping most of the patients
reasonably well in 5 to 10 years after treatment - but does not guarantee
survival nor wellbeing.
The more we go beyond this period, the greater chance of suffering
chronic diseases and dying, as a result of the long-term damage inflicted
by treatment's toxicity. Majority of children patients is bound to suffer from one or
more chronic diseases, including those life-threatening. Their chances
of being dead 20 years or more after being treated are
to be alive.
For Daniel Hauser, that would be only 33 years of age.
And he is not alone. According to the National Cancer Institute,
some 850-900 children and adolescents below 20 years of age are
diagnosed with Hodgkin's every year. Expectedly, Daniel's drama is
not the first one, nor the last. Let's look at some of those stories
that have caught public attention.
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