Less Is More?
- It appears the popular phrase “less is more” rings true when it comes to treating ovarian and esophageal cancer and Hodgkin’s lymphoma, new findings presented at the 2024 American Society of Clinical Oncology (ASCO) annual meeting reveal.
- Researchers from three different studies found that less surgery, less chemotherapy or less radiation can lead to more progress for those battling those three types of cancer.
- It’s important to remember that several factors go into deciding what kind of treatment is best when it comes to ovarian cancer, depending on the type and stage of the cancer, your age, and whether you are planning to have children in the future. Surgery is usually the first treatment recommended, with chemotherapy afterward to get rid of any cancer that may have been left behind. The other option is to have chemotherapy first, called neoadjuvant chemotherapy, to shrink the tumor so that it’s easier to remove surgically.
- “Esophageal cancer, we know is a tough one,” Dr. Brendon Stiles, a thoracic surgeon at Montefiore Medical Center, previously told SurvivorNet. “It’s one of the cancers with some of the lowest cure rates out there, but like many cancers, if we find it early, we can often treat it effectively, either with surgery, with surgery and chemotherapy, with chemotherapy and radiation.”
- As for treating Hodgkin lymphoma, your doctor will tailor your treatment to the stage of your cancer, as well as other factors, such as how aggressive it is. Chemotherapy is generally part of the treatment at every stage. But in the early stages, radiation may be added, because stage I and II lymphomas tend to respond well to radiation.
New findings presented at the 2024 American Society of Clinical Oncology (ASCO)
annual meeting , a major annual conference where professionals share their latest research in cancer, has revealed that "less" intensive treatment actually results in more progress when it comes to battling ovarian and esophageal cancer, and Hodgkin lymphoma. Researchers from recent studies on those three types of cancers have discovered that less surgery, less chemotherapy or less radiation can lead to more progress for people diagnosed with either of those cancers, the
Associated Press reports in a compilation of research. The uplifting news comes about 30 years after
one study looked into whether high‐dose chemotherapy and autologous bone marrow or stem cell transplantation was better than conventional chemotherapy for those battling metastatic breast cancer. The study found that intensive treatment didn't work better than the normal amount. Dr. Tatjana Kolevska, medical director for the Kaiser Permanente National Cancer Excellence Program who has no involvement in the new research, told AP news, the question of whether all the treatment used in the past is actually needed "should be asked over and over again." Additionally, Dr. William G. Nelson of Johns Hopkins School of Medicine, who was also not involved in the studies, told AP News, "The good news is that cancer treatment is not only becoming more effective, it’s becoming easier to tolerate and associated with less short-term and long-term complications."
Ovarian Cancer Treatment
It's interesting to point out that
ovarian cancer, which has been called the "cancer that whispers" because women often don’t experience symptoms until their cancer has already reached its late stages, was one of the diseases found not to be affected negatively by less treatment. AP News pointed out how French researchers discovered it's safe to avoid removing lymph nodes that seem healthy amid a surgical procedure for advanced ovarian cancer.
RELATED: Ovarian Cancer: What Are The Symptoms And Warning Signs? The study, dubbed the
phase III CARACO trial, was explained by
The ACSO Post as having looked at 379 patients with advanced epithelial ovarian cancer whose lymph nodes showed no signs of cancer before or during surgery to remove their primary cancer. Half of the patients had their lymph nodes removed and the other half did not.
Ovarian Cancer Diagnosis: The Importance of Biomarkers The research, which began in 2008 and was funded by the National Cancer Institute in France, found that "after a median follow-up of 9 years, researchers found that omitting lymphadenectomy did not impact survival outcomes," The ACSO Post explains. The study's lead author Jean-Marc Classe, MD, PhD, of Institut de Cancerologie de l'Ouest, Nantes University, said, "We already had similar results in patients treated for advanced ovarian cancer with primary surgery followed with adjuvant chemotherapy from the LION trial, which was published [by Harter et al in
The New England Journal of Medicine ] in 2019. "Today, the more frequent strategy in the case of advanced ovarian cancer is interval surgery…. After the publication of the LION trial, the remaining question was: what is the best strategy for considering the removal of the lymph nodes after neoadjuvant chemotherapy? CARACO helps answer this question for some patients."
Should you get surgery first, or chemotherapy? Gynecologic oncologist Dr. John Nakayama outlines your options. Offering some perspective from the ACSO, Michael C. Lowe, MD, MA, of Emory University School of Medicine, commented, "This randomized phase III clinical trial shows that patients undergoing surgery for advanced ovarian cancer may be able to safely avoid having additional lymph nodes removed that do not appear to be involved with the primary cancer. "While this study’s conclusion does not definitively show a difference between the two groups of patients, this is an important example of surgeons working to decrease the morbidity of surgery without compromising outcomes for people with cancer. There is still a need for better systemic therapies to improve outcomes in patients with advanced ovarian cancer." Meanwhile, it's important to remember that several factors go into deciding what kind of treatment is best when it comes to ovarian cancer, depending on the type and
stage of the cancer, your age, and whether you are planning to have children in the future. Surgery is usually the first treatment recommended, with chemotherapy afterward to get rid of any cancer that may have been left behind. The other option is to have chemotherapy first, called
neoadjuvant chemotherapy , to shrink the tumor so that it's easier to remove surgically.
Gynecologic oncologist Dr. Adam ElNaggar, on what you can expect if you get chemotherapy for ovarian cancer If a doctor is confident that he or she can remove the ovarian tumor completely without initial cycles of chemotherapy, they will go ahead with a surgical procedure. Doctors who are not confident they can perform successful surgical tumor removal will go with chemotherapy initially, then proceed with surgery once tumors have shrunk.
Esophageal Cancer Treatment
As for treating cancer of the esophagus, a recent German study that looked at 438 people with this disease, found they can simply be treated with surgery, it was revealed at the conference.
Esophageal Cancer Early Detection and First Steps "Half received a common treatment plan that included chemotherapy and surgery on the esophagus, the tube that carries food from the throat to the stomach," AP News explains.
RELATED: Why Are More Young People Getting Devastating Cancer of The Esophagus? Understanding the Disease and Trends in Diagnoses "Half got another approach that includes radiation too. Both techniques are considered standard. Which one patients get can depend on where they get treatment." According to the study, which was founded by The German Research Foundation, after three years, 57% of patients who received chemo and surgery were alive, in comparison to to 51% of those who got chemo, surgery and radiation.
Esophageal Cancer: Getting Emotional Support Esophageal cancer is a disease that causes cancer cells to form in the tissues of the esophagus, a hollow, muscular tube that food and liquid move through when traveling from the throat to the stomach. The wall of the esophagus is made of up several layers of tissue; cancer begins on the inside lining and spreads to the outer layers of the esophagus as it grows.
Expert Resources On Esophageal Cancer
Several lifestyle factors, like smoking or heavy alcohol use, can increase a person’s risk of developing esophageal cancer. “Esophageal cancer, we know is a tough one,”
Dr. Brendon Stiles , a thoracic surgeon at Montefiore Medical Center, previously told SurvivorNet. “It’s one of the cancers with some of the lowest cure rates out there, but like many cancers, if we find it early, we can often treat it effectively, either with surgery, with surgery and chemotherapy, with chemotherapy and radiation.” Dr. Stiles recommends that patients report any symptoms that may indicate esophageal cancer to their doctors right away, since there are more treatment options when the cancer is caught early.
Hodgkin Lymphoma Treatment
As for advanced Hodgkin lymphoma, different research, funded by Takeda Oncology and presented during the ACSO's recent conference, looked into two types of chemotherapy regimens for advanced Hodgkin lymphoma. The findings ultimately revealed the less intensive treatment to be more effective for the blood cancer, as well as resulting in fewer side effects.
What Does It Mean to Have Advanced-Stage Lymphoma? "After four years, the less harsh chemo kept the disease in check in 94% of people, compared to 91% of those who had the more intense treatment," AP News explains. "The trial included 1,482 people in nine countries — Germany, Austria, Switzerland, the Netherlands, Denmark, Sweden, Norway, Australia and New Zealand." When it comes to understanding lymphoma, basically it's a type a cancer of the immune system that affects infection-fighting cells called lymphocytes. And there are more than 40 different types of lymphoma.
Dr. Elise Chong explains why your type of lymphoma matters "Lymphoma is split up into a number of different categories,"
Dr. Elise Chong , a medical oncologist at Penn Medicine, tells SurvivorNet. "The first distinguishing breakpoint, if you will, is
non-Hodgkin lymphoma versus Hodgkin lymphoma," she adds, "and those sound like two different categories. But non-Hodgkin lymphoma comprises the majority of lymphoma, and Hodgkin lymphoma is a single specific type of lymphoma." Hodgkin lymphoma has distinctive, giant cells called Reed-Sternberg cells. The presence of these cells, which can be seen under a microscope, will help your doctor determine which of the two lymphoma types you have. There are a few other important differences between non-Hodgkin lymphoma and Hodgkin lymphoma to note. For one thing, non-Hodgkin lymphoma is much more common. And you're more likely to be diagnosed with it after age 55. People usually develop Hodgkin lymphoma at a younger age. It should be noted that another difference between these two types of lymphoma is that non-Hodgkin lymphoma is more likely to spread in a random fashion and be found in different groups of lymph nodes in the body, while Hodgkin lymphoma is more likely to grow in a uniform way from one group of lymph nodes directly to another. These two different types of lymphoma behave, spread and respond to treatment differently, so it's important for you to know which type you have. Your doctor will tailor your treatment to the stage of your cancer, as well as other factors, such as how aggressive it is. Chemotherapy is generally part of the treatment at every stage. But in the early stages, radiation may be added, because stage I and II lymphomas tend to respond well to radiation.
Contributing: SurvivorNet Staff 
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