Scots medics pioneer children's cancer cure that preserves fertility

Published on Saturday 29 December 2007 20:54

CHILDREN being treated for cancer will have their future fertility preserved under a groundbreaking new treatment trialled by Scottish doctors.

Scotland on Sunday can reveal experts have launched a revolutionary new therapy for one of the commonest children's cancers, Hodgkin's lymphoma, for which previous treatments have the devastating side-effect of damaging the reproductive system and leaving patients unable to have babies of their own.

Other dangerous side-effects of the existing treatment, which doctors also hope to improve, include other cancers and heart failure later on in life.

But trials on patients in Edinburgh have revealed that giving minimum doses of chemotherapy and avoiding treatment with radiotherapy altogether is just as effective in treating the cancer without the devastating side-effects.

Hodgkin's lymphoma is a malignant cancer that affects the lymph nodes and causes lumps in the neck and around the body. It is not known exactly what causes the cancer but it is more common in young people than in other age groups.

The cancer, which affects 100 children in the UK every year, has high survival rates, but up to 90% of patients are unable to go on and have children of their own.

Many other patients suffer from further cancers 20 years after undergoing radiotherapy because the powerful rays used to destroy the cancer cells can also cause lasting damage to the body.

Dr Hamish Wallace, a consultant paediatric oncologist at the Royal Hospital for Sick Children in Edinburgh and president of the European Network for Paediatric Hodgkin's Lymphoma, said the discovery would offer reassurance to parents with children facing a battle against cancer.

He said: "I feel really positive about patients with Hodgkin's because we can get them better. This type of cancer is very curable for many youngsters. But it has left them infertile because the treatment is potentially sterilising.

"In boys it can leave them with no sperm and in girls it can damage their supply of eggs and bring on an early menopause.

"We hope to no longer sterilise our survivors. It's all a balance. We want to cure them, leave them fertile, and not give them further malignancies. This is a new regimen.

"We expect to enter 80 to 100 patients into the programme from the UK.

"The philosophy behind the trial is to check that we are not getting an increased number of relapses. We are removing a treatment so we are checking that is safe to do that. But the data so far, from the patients we have treated in Edinburgh, suggests that this is safe."

In the traditional treatment programme for Hodgkin's lymphoma, patients are given a combination of chemotherapy drugs and radiotherapy.

Wallace and his colleagues have now refined this treatment and the new regime will be launched at hospitals in 14 countries across Europe early in the new year.

The move follows a study of children at the Royal Hospital for Sick Children in Edinburgh, who were given the new treatment regime by Wallace and found to be cured of the cancer as effectively as patients undergoing the traditional regime.

Patients will first be assessed to see how advanced their cancer is. They will be given two doses of chemotherapy and then they will be scanned using positron emission tomography (PET) to see how the cancer is responding.

The PET scan can show how well chemotherapy is working by using a radioactive substance injected into the body.

If the cancer is responding well, no radiation will be used, and up to half of all patients are expected not to need it.

Those with more advanced cancer will be given a further two doses of chemotherapy and monitored by PET scan, while those with the most advanced cancer will be given six doses of chemotherapy. Radiation would only be used as a last resort if the cancer was not responding to treatment.

In addition to reducing the dose of radiotherapy, there will be changes in the type of chemotherapy given to children.

One commonly used chemotherapy drug, procarbazine, will be removed from the treatment regime because it has the side-effect of affecting patients' fertility by damaging boys' sperm production and causing an early menopause in girls.

In its place a newer drug, dacarbazine, will be used, which is less likely to affect fertility. In addition, doctors will attempt to limit the dosage of another chemotherapy drug, anthracycline, which can cause heart failure later in life.