To compare radiotherapy alone to chemotherapy plus radiotherapy in the treatment of early stage Hodgkin's disease, the English language medical literature was searched for reports on randomized clinical trials in Stages I and I1 Hodgkin's disease from 1975 through 1986. Twenty-three reports with 2999 patients were entered into matched study analysis. Data on extended-field radiotherapy (EF), involved-field (IF), chemotherapy alone, combination chemotherapy and radiotherapy (CM), disease stage, laparotomy staging, and complications were gathered. A proportional hazard rate was used to estimate and compare relapsefree (RFS) and overall survival rates (S). Iteratively reweighted least square analysis was used to estimate survival curves. Twelve-year RFS for CM (889 patients) was significantly superior to EF (1350 patients) (P < 0.01). Twenty-year RFS in EF was better than IF (760 patients) (P < 0.01). Twelve-year S for CM was not significantly different than for EF but was better than for IF (P < 0.05).Cancer 65:1155-1160, 1990.HE MANAGEMENT of Stages 1 and 11 Hodgkin's dis-T ease is controversial. 1-4 Proponents of radiotherapy alone (after laparotomy staging) cite a decreased risk of secondary hematologic malignancies and chemotherapyrelated toxicities with excellent results of chemotherapybased salvage if necessary. Proponents of initial chemotherapy avoid laparotomy-related sequelae as well as the even higher rate of secondary leukemia in patients subjected to initial radiotherapy and subsequent salvage chemotherapy. In addition, it is apparent that salvage chemotherapy is not always entirely effective in achieving cure.5To improve our understanding of the optimal therapeutic modality for Stage I and I1 Hodgkin's disease, we chose to do a meta-analysis of the English language literature addressing this issue. Many randomized controlled trials on Hodgkin's disease management are too small to detect clinically important differences. However, metaanalysis allowed us to summarize results of different randomized studies, thus increasing the statistical power of study endpoints and resolving the differences between studies.6-8The objectives of our study were as follows: (1) to determine relapse-free survival (RFS) rates based on treatment modality (involved-field radiotherapy [IF], extended-field radiotherapy [EF], combined modality therapy [CM], i.e., radiation and chemotherapy, or chemotherapy alone; (2) to determine overall survival (S) rates based on treatment modality; (3) to determine the effect on RFS and S of laparotomy staging or no laparotomy staging; and (4) to determine complications and long-term toxicities related to treatment modalities.
Materials and Methods
Literature SearchThe English language literature was searched for reports on clinical trials in Stages I and I1 Hodgkin's disease from January 1975 to December 1986. The search was conducted from Index Medicus, from a Med Line (National Library of Medicine MEDLARS Retrieval System, Bethesda, Maryland) computerized search, from reviewing the refere...
