Randomized Trial of Chemotherapy Versus Chemotherapy Plus Radiotherapy for Stage I-II Hodgkin's Disease

Pavlovsky, Santiago; Maschio, Mabel; Santarelli, María Teresa; Muriel, Federico Sackmann; Corrado, Claudia; I, García; Schwartz, Laura; Montero, Carlos Segundo; Sanahuja, F Lobo; Magnasco, Osvaldo; Raha, Roberto; Cavagnaro, F

doi:10.1093/jnci/80.18.1466

Cited by 141 publications

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“…21,27,29,30 The relative risk of reaching CR was 1.07 (95% confidence interval (CI) =0.98 to 1.17). Due to the small number of trials, subgroup and sensitivity analyses were not performed.…”

Section: Complete Response Ratementioning

confidence: 99%

“…Inclusion criteria regarding risk factors also differed. While three trials in the main analysis included both patients with early favorable and early unfavorable stages, 21,28,30 the EORTC H9-F trial 29 included only patients with early favorable disease. In contrast, the Mexico B2H031 trial 27 had only patients with bulky disease.…”

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confidence: 99%

“…Two older trials used CVPP (cyclophosphamide, vinblastine, procarbazine, prednisone). 28,30 Recruitment ranged from the 1970s 28 median follow-up was two to 12 years. Four trials randomized patients at diagnosis, while the EORTC-GELA H9-F trial 29 randomized patients after achieving CR after chemotherapy.…”

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confidence: 99%

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Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Herbst¹,

Rehan²,

Brillant³

et al. 2009

Haematologica

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The online version of this article has a supplementary appendix.Combined modality treatment (CMT) of chemotherapy followed by localized radiotherapy is standard treatment for patients with early stage Hodgkin's lymphoma. However, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. We thus performed a systematic review with meta-analysis of randomized controlled trials comparing chemotherapy alone with CMT in patients with early stage Hodgkin's lymphoma with respect to response rate, tumor control and overall survival (OS). We searched Medline, EMBASE and the Cochrane Library as well as conference proceedings from January 1980 to February 2009 for randomized controlled trials comparing chemotherapy alone versus the same chemotherapy regimen plus radiotherapy. Progression free survival and similar outcomes were analyzed together as tumor control. Effect measures used were hazard ratios for OS and tumor control as well as relative risks for complete response (CR). Meta-analyses were performed using RevMan5. Five randomized controlled trials involving 1,245 patients were included. The hazard ratio (HR) was 0.41 (95% confidence interval (CI) 0.25 to 0.66) for tumor control and 0.40 (95% CI 0.27 to 0.59) for OS for patients receiving CMT compared to chemotherapy alone. CR rates were similar between treatment groups. In sensitivity analyses another 6 trials were included that did not fulfill the inclusion criteria of our protocol but were considered relevant to the topic. These trials underlined the results of the main analysis. In conclusion, adding radiotherapy to chemotherapy improves tumor control and OS in patients with early stage Hodgkin's lymphoma.Key words: combined modality treatment, chemotherapy, Hodgkin's lymphoma.Citation: Herbst C, Rehan FA, Brillant C, Bohlius J, Skoetz N, Schulz H, Monsef I, Specht L, and Engert A. Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review. Haematologica. 2010.95:494-500. doi:10.3324/haematol.2009 This is an open-access paper. ABSTRACT therapy.The main objective of this systematic review was to compare chemotherapy alone with identical chemotherapy plus radiotherapy in patients with early stage HL with respect to overall survival, tumor control and complete response rates.

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Section: Complete Response Ratementioning

confidence: 99%

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confidence: 99%

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Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Herbst¹,

Rehan²,

Brillant³

et al. 2009

Haematologica

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“…Comparing combination therapy with chemotherapy alone also reveals better relapse-free survival with combination therapy, but no difference in overall survival (36).…”

Section: Cornhalion Rudiotlierupy Und Clzemotherupvmentioning

confidence: 93%

Hodgkin's Disease

Gustafsson¹

1996

Acta Oncologica

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“…A review of randomized trials testing chemotherapy alone in patients with limited-stage disease, and synopsis of potential limitations, is shown in Table 3. Eight randomized trials 14,[16][17][18][19][20][21][22] testing chemotherapy alone in patients with limited-stage disease have been reported, either as specific trials or as subset analyses of larger trials. Four of these trials tested chemotherapy that has been shown to be inferior to ABVD or its equivalent 14,[16][17][18] and thus these treatments cannot be recommended and the trials do not adequately test currently available chemotherapy as a single modality.…”

Section: Evolution To Current Standards Of Carementioning

confidence: 99%

The Management of Patients with Limited-Stage Classical Hodgkin Lymphoma

Gospodarowicz

Meyer

2006

Hematology

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The term limited-stage Hodgkin lymphoma refers to those patients with stage I-II disease and an absence of bulky disease. Among those patients with classical Hodgkin lymphoma, approximately one-third of patients will fall into this category. As long-term disease control can now be anticipated in more than 90% of these patients, management strategies must increasingly address the need to reduce the long-term treatment-related risks. Current treatment options include use of combined modality therapy that includes an abbreviated course of chemotherapy and involved-field radiation or treatment with chemotherapy, currently consisting of ABVD, as a single modality. The choice of treatment between these two options involves specific trade-offs that must balance issues of disease control against long-term risk of late effects.

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Randomized Trial of Chemotherapy Versus Chemotherapy Plus Radiotherapy for Stage I-II Hodgkin's Disease

Cited by 141 publications

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Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Hodgkin's Disease

The Management of Patients with Limited-Stage Classical Hodgkin Lymphoma

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