Author:

Keywords:

Adolescent, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Bleomycin, Combined Modality Therapy, Disease-Free Survival, Doxorubicin, Female, Hodgkin Disease, Humans, Logistic Models, Male, Mechlorethamine, Mediastinal Neoplasms, Middle Aged, Neoplasms, Second Primary, Prednisone, Procarbazine, Remission Induction, Survival Rate, Vinblastine, Vincristine, Science & Technology, Life Sciences & Biomedicine, Oncology, Radiology, Nuclear Medicine & Medical Imaging, Hodgkin's lymphoma, advanced stage, partial remission, radiotherapy, combined modality treatment, STEM-CELL-TRANSPLANTATION, POSITRON-EMISSION-TOMOGRAPHY, HIGH-DOSE CHEMOTHERAPY, DETUDES-DES-LYMPHOMES, LADULTE H89 TRIAL, RANDOMIZED-TRIAL, DISEASE PATIENTS, STANFORD-V, STAGE, ABVD, European Organization for Research and Treatment of Cancer (EORTC) Lymphoma Group, 0299 Other Physical Sciences, 1103 Clinical Sciences, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis, 3211 Oncology and carcinogenesis, 3407 Theoretical and computational chemistry, 5105 Medical and biological physics

Abstract:

PURPOSE: The use of radiotherapy in patients with advanced Hodgkin's lymphoma (HL) is controversial. The purpose of this study was to describe the role of radiotherapy in patients with advanced HL who were in partial remission (PR) after chemotherapy. METHODS: In a prospective randomized trial, patients <70 years old with previously untreated Stage III-IV HL were treated with six to eight cycles of mechlorethamine, vincristine, procarbazine, prednisone/doxorubicin, bleomycine, vinblastine hybrid chemotherapy. Patients in complete remission (CR) after chemotherapy were randomized between no further treatment and involved-field radiotherapy (IF-RT). Those in PR after six cycles received IF-RT (30 Gy to originally involved nodal areas and 18-24 Gy to extranodal sites with or without a boost). RESULTS: Of 739 enrolled patients, 57% were in CR and 33% in PR after chemotherapy. The median follow-up was 7.8 years. Patients in PR had bulky mediastinal involvement significantly more often than did those in CR after chemotherapy. The 8-year event-free survival and overall survival rate for the 227 patients in PR who received IF-RT was 76% and 84%, respectively. These rates were not significantly different from those for CR patients who received IF-RT (73% and 78%) or for those in CR who did not receive IF-RT (77% and 85%). The incidence of second malignancies in patients in PR who were treated with IF-RT was similar to that in nonirradiated patients. CONCLUSION: Patients in PR after six cycles of mechlorethamine, vincristine, procarbazine, prednisone/doxorubicine, bleomycine, vinblastine treated with IF-RT had 8-year event-free survival and overall survival rates similar to those of patients in CR, suggesting a definite role for RT in these patients.