Randomized trial of chemotherapy versus chemotherapy plus radiotherapy for stage III-IV A &B Hodgkin's disease

Abstract

A total of 151 patients with previously untreated Hodgkin's disease, clinical stages III-IV A & B, were randomized to receive CVPP for 6 cycles, or CVPP plus RT 3000 cGy to previously involved areas between the 3rd and 4th cycles. CVPP consists of cyclophosphamide 600 mg/m2/i.v., vinblastine 6 mg/m2/i.v. on day 1, procarbazine 100 mg/m2/p.o. and prednisone 40 mg/m2/p.o. on days 1 to 14. Both groups displayed similar clinical characteristics at diagnosis. Sixty-six were treated with CVPP + RT (52 St III and 14 St IV) and 85 with CVPP alone (68 St III and 17 St IV). Complete remission was obtained in 57 (86%) of 66 patients who received CVPP plus RT, and in 62 (73%) of 85 patients treated with CVPP. Five and sixteen patients, respectively, achieved partial responses, while 2 in each group died during treatment. At 7 years, duration of complete remission and failure-free survival were: 51% and 45% for those treated with CVPP plus RT, and 23% and 21% with CVPP alone (p = 0.0150 and P = 0.0016, respectively). Overall survival at 7 years was 71% and 58%, respectively (p = 0.1488). A dose analysis performed in 84 pts showed that 91% and 88% received full protocol doses of CPM and PCZ, respectively, in the CVPP + RT group, and 95% and 94% for CVPP. The WBC nadir was 3.5 and 3.7 x mm3, respectively. Of 25 pts on CVPP + RT who relapsed, 9 are now disease-free, 5 are alive with disease and 11 have died, and with CVPP, of 37 relapsing pts, 18 are disease-free, 5 are alive with disease and 14 are dead.(ABSTRACT TRUNCATED AT 250 WORDS)

Early-Stage Classic Hodgkin Lymphoma: The Utilization of Radiation Therapy and Its Impact on Overall Survival

“…[5][6][7][8]18,[21][22][23][24][25][26] [27] and may be associated with higher rates of late-term side effects, such as secondary malignancies. [28] The relative infrequent use of RT at academic/research programs, demonstrated in this study, may be explained by greater access and comfort with salvage programs such as ASCT.…”

“…[29] Studies have found the relative risk of death from cardiovascular disease persists >20 years after treatment and is related to RT doses >3,000cGy, supra-diaphragmatic fields, and exposure to anthracycline/alklyating agents. 24,26 With effective chemotherapy regimens, modern RT field reductions now only include the involved site and treatment to much lower doses. [1,2,4,30,31] This study reflects a time period in which STLI and EFRT was no longer standard practice and the movement toward IFRT/ISRT [32] Field reduction to the "involved-node" has been estimated to reduce 25-year absolute excess risk of cardiac events by 5.1% when compared to traditional mantle fields.…”

Relapse Analysis of Irradiated Patients Within the HD15 Trial of the German Hodgkin Study Group

“…The role of consolidative RT after intense CTX for patients in advanced stages is discussed controversially. Results of randomized trials challenged the benefit of adjuvant RT (4)(5)(6)(7)(8)(9), and therefore the European Organization for Research and Treatment of Cancer (EORTC) conducted a trial to determine the role of consolidative RT after CTX. The data of this analysis showed no improvement in outcome when adding consolidative involved-field RT (IF-RT) for patients in complete remission after CTX (10).…”

Hodgkin's Disease

“…and the United States have been unable to clearly show improved disease-free or overall survival with additional radiotherapy (67,74). A randomized study from Argentina reported better disease-free survival, although no difference in overall survival, with combination therapy than with chemotherapy (75). However, optimum chemotherapy was not used, and unusually high recurrence was noted in the irradiated areas.…”