Involved-field radiotherapy for advanced Hodgkin's lymphoma.
BACKGROUND
The use of involved-field radiotherapy after chemotherapy for advanced Hodgkin's lymphoma is controversial.


METHODS
We randomly assigned patients with previously untreated stage III or IV Hodgkin's lymphoma who were in complete remission after hybrid chemotherapy with mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP-ABV) to receive either no further treatment or involved-field radiotherapy. Radiotherapy consisted of 24 Gy to all initially involved nodal areas and 16 to 24 Gy to all initially involved extranodal sites. Patients in partial remission were treated with 30 Gy to nodal areas and 18 to 24 Gy to extranodal sites.


RESULTS
Of 739 patients, 421 had a complete remission; 161 of these patients were assigned to no further treatment, and 172 to involved-field radiotherapy. The median follow-up was 79 months. The five-year event-free survival rate was 84 percent in the group that did not receive radiotherapy and 79 percent in the group that received involved-field radiotherapy (P=0.35). The five-year overall survival rates were 91 and 85 percent, respectively (P=0.07). Among the 250 patients in partial remission after chemotherapy, the five-year event-free and overall survival rates were 79 and 87 percent, respectively.


CONCLUSIONS
Involved-field radiotherapy did not improve the outcome in patients with advanced-stage Hodgkin's lymphoma who had a complete remission after MOPP-ABV chemotherapy. Radiotherapy may benefit patients with a partial response after chemotherapy.
Aleman
Berthe M P
BM
Netherlands Cancer Institute, Amsterdam, The Netherlands. b.aleman@nki.nl
Raemaekers
John M M
JM
Tirelli
Umberto
U
Bortolus
Roberto
R
van 't Veer
Mars B
MB
Lybeert
Marnix L M
ML
Keuning
Jo J
JJ
Carde
Patrice
P
Girinsky
Théodore
T
van der Maazen
Richard W M
RW
Tomsic
Radka
R
Vovk
Marjeta
M
van Hoof
Achilles
A
Demeestere
Geertrui
G
Lugtenburg
Pieternella J
PJ
Thomas
José
J
Schroyens
Wilfried
W
De Boeck
Koenraad
K
Baars
Johanna W
JW
Kluin-Nelemans
Johanna C
JC
Carrie
Christian
C
Aoudjhane
Malek
M
Bron
Dominique
D
Eghbali
Houchingue
H
Smit
Wilma G J M
WG
Meerwaldt
Jacobus H
JH
Hagenbeek
Anton
A
Pinna
Antonella
A
Henry-Amar
Michel
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012074:Remission Induction; D016019:Survival Analysis; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D004317:Doxorubicin; D011241:Prednisone