title: Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group.
abstract: OBJECTIVE
  We report results of a randomized trial comparing ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy alone with treatment that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma.
  
  
  METHODS
  Patients with nonbulky clinical stage I to IIA Hodgkin's lymphoma were stratified into favorable and unfavorable risk cohorts. Patients allocated to radiation-containing therapy received subtotal nodal radiation if favorable risk or combined-modality therapy if unfavorable risk. Patients allocated to ABVD received four to six treatment cycles.
  
  
  RESULTS
  We evaluated 399 patients. Median follow-up is 4.2 years. In comparison with ABVD alone, 5-year freedom from disease progression is superior in patients allocated to radiation therapy (P = .006; 93% v 87%); no differences in event-free survival (P = .06; 88% v 86%) or overall survival (P = .4; 94% v 96%) were detected. In a subset analyses comparing patients stratified into the unfavorable cohort, freedom from disease progression was superior in patients allocated to combined-modality treatment (P = .004; 95% v 88%); no difference in overall survival was detected (P = .3; 92% v 95%). Of 15 deaths observed, nine were attributed to causes other than Hodgkin's lymphoma or acute treatment-related toxicity.
  
  
  CONCLUSIONS
  In patients with limited-stage Hodgkin's lymphoma, no difference in overall survival was detected between patients randomly assigned to receive treatment that includes radiation therapy or ABVD alone. Although 5-year freedom from disease progression was superior in patients receiving radiation therapy, this advantage is offset by deaths due to causes other than progressive Hodgkin's lymphoma or acute treatment-related toxicity.
authors.affiliation: Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada. ralph.meyer@hrcc.on.ca
authors.forename: Ralph M
authors.initials: RM
authors.lastname: Meyer
authors.forename: Mary K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.forename: Robert G
authors.initials: RG
authors.lastname: Pearcey
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Woodrow A
authors.initials: WA
authors.lastname: Wells
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Burns
authors.forename: Jane N
authors.initials: JN
authors.lastname: Winter
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Horning
authors.forename: A Rashid
authors.initials: AR
authors.lastname: Dar
authors.forename: Marina S
authors.initials: MS
authors.lastname: Djurfeldt
authors.forename: Keyue
authors.initials: K
authors.lastname: Ding
authors.forename: Lois E
authors.initials: LE
authors.lastname: Shepherd
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D015996:Survival Rate; D014747:Vinblastine / Q000627:therapeutic use*
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin