title: Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin's lymphoma: results of the HD8 trial of the German Hodgkin's Lymphoma Study Group.
abstract: OBJECTIVE
  To investigate whether radiotherapy can be reduced without loss of efficacy from extended field (EF) to involved field (IF) after four cycles of chemotherapy.
  
  
  METHODS
  Between 1993 and 1998, patients with newly diagnosed early-stage unfavorable HD were enrolled onto this multicenter study. Patients were randomly assigned to receive cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) + doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for two cycles followed by radiotherapy of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B).
  
  
  RESULTS
  Of 1,204 patients randomly assigned to treatment, 1,064 patients were informative and eligible for the arm comparison (532 patients in arm A; 532 patients in arm B). The median observation time was 54 months. Five years after random assignment, the overall survival (OSran) for all eligible patients was 91% and freedom from treatment failure (FFTFran) was 83%. Survival rates at 5 years after start of radiotherapy revealed no differences for arms A and B, respectively, in terms of FFTF (85.8% and 84.2%) and OS at 5 years (90.8% and 92.4%). There also were no differences between arms A and B, respectively, in terms of complete remission (98.5% and 97.2%), progressive disease (0.8% and 1.9%), relapse (6.4% and 7.7%), death (8.1% and 6.4%), and secondary neoplasia (4.5% and 2.8%). In contrast, acute side effects including leukopenia, thrombocytopenia, nausea, gastrointestinal toxicity, and pharyngeal toxicity were more frequent in the EF arm.
  
  
  CONCLUSIONS
  Radiotherapy volume size reduction from EF to IF after COPP + ABVD chemotherapy for two cycles produces similar results and less toxicity in patients with early-stage unfavorable HD.
authors.affiliation: Department I of Internal Medicine, University Hospital Cologne, Cologne 50924, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Petra
authors.initials: P
authors.lastname: Schiller
authors.forename: Andreas
authors.initials: A
authors.lastname: Josting
authors.forename: Richard
authors.initials: R
authors.lastname: Herrmann
authors.forename: Peter
authors.initials: P
authors.lastname: Koch
authors.forename: Markus
authors.initials: M
authors.lastname: Sieber
authors.forename: Friederike
authors.initials: F
authors.lastname: Boissevain
authors.forename: Maike
authors.initials: M
authors.lastname: De Wit
authors.forename: Jorg
authors.initials: J
authors.lastname: Mezger
authors.forename: Eckhart
authors.initials: E
authors.lastname: Duhmke
authors.forename: Normann
authors.initials: N
authors.lastname: Willich
authors.forename: Rolf-Peter
authors.initials: RP
authors.lastname: Muller
authors.forename: Bernhard F
authors.initials: BF
authors.lastname: Schmidt
authors.forename: Helmut
authors.initials: H
authors.lastname: Renner
authors.forename: Hans Konrad
authors.initials: HK
authors.lastname: Muller-Hermelink
authors.forename: Beate
authors.initials: B
authors.lastname: Pfistner
authors.forename: Jurgen
authors.initials: J
authors.lastname: Wolf
authors.forename: Dirk
authors.initials: D
authors.lastname: Hasenclever
authors.forename: Markus
authors.initials: M
authors.lastname: Loffler
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone