Six years ago the BC Cancer Agency acquired the latest in scanning technology – a positron emission tomographic (PET) scanner, which allows clinicians to accurately assess whether all cancer cells within a tumour under treatment have been destroyed.

With access to PET scanning and building on research findings from a major Canadian clinical trial at that time, the BC Cancer Agency’s Lymphoma Tumour Group decided to see if radiation could be eliminated from the treatment for most patients with limited-stage Hodgkin lymphoma, a cancer of specialized white blood cells, or lymphocytes, which help fight infection and disease within the body.

At the time, the standard approach to treating Hodgkin lymphoma involved radiation therapy in combination with chemotherapy. Although the approach was effective – providing a cure for more than 90 percent of patients with limited-stage Hodgkin lymphoma – exposing patients to radiation elevates their risk of developing other disorders, including heart problems and potentially even secondary cancers.

“The problem with radiation is that as it passes through tissues in the body it damages the normal tissue in addition to the cancer tissue,” says Dr. Joseph Connors, clinical director of The BC Cancer’s Centre for Lymphoid Cancer. “For Hodgkin lymphoma, the radiation usually has to be delivered to the central portion of the chest, which raises concerns about damage to the heart and, even worse, a future risk for lung cancer and soft tissue sarcomas, as well as breast cancer for young women.”

Equipped with the advanced capabilities of PET scanning, Connors says BC Cancer clinicians decided to trial a new treatment approach for the 20 British Columbians who develop limited-stage Hodgkin lymphoma each year, reserving radiation for only those patients not completely cured through chemotherapy alone.

“We always provide our patients with the best available treatments,” says Connors, “but we also want to minimize any harm that might come from treatment.” In adopting chemotherapy supported by PET scanning as its standard treatment for limited-stage Hodgkin lymphoma, the BC Cancer Agency became the first treatment facility in Canada and one of the first in North America to limit the use of radiation therapy for these patients.

Today, cure rates for British Columbians with limited-stage Hodgkin lymphoma continue to exceed 95 percent but now more than 80 percent of these patients are treated without radiation. Based on these excellent results other treatment centres across North America have followed the BC Cancer Agency’s lead and have adopted this treatment approach to the disease.

In addition to the clinical benefits, the BC Cancer Agency’s approach to treating limited-stage Hodgkin lymphoma also provided significant cost savings. The average cost of radiation therapy is about $10,000 per patient, compared to $400 for chemotherapy.

Dr. Joseph Connors is clinical director of the BC Cancer Agency Centre for Lymphoid Cancer and a clinical professor in the Faculty of Medicine at UBC.