Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin's lymphoma: final results of the GHSG HD7 trial.
OBJECTIVE
To investigate whether combined-modality treatment (CMT) with two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by extended-field radiotherapy (EF-RT) is superior to EF-RT alone in patients with early favorable Hodgkin's lymphoma (HL).


METHODS
Between 1993 and 1998, 650 patients with newly diagnosed, histology-proven HL in clinical stages IA to IIB without risk factors were enrolled onto this multicenter study and randomly assigned to receive 30 Gy EF-RT plus 10 Gy to the involved field (arm A) or two cycles of ABVD followed by the same radiotherapy (arm B). Results At a median observation time of 87 months, there was no difference between treatment arms in terms of complete response rate (arm A, 95%; arm B, 94%) and overall survival (at 7 years: arm A, 92%; arm B, 94%; P = .43). However, freedom from treatment failure was significantly different, with 7-year rates of 67% in arm A (95% CI, 61% to 73%) and 88% in arm B (95% CI, 84% to 92%; P <or= .0001). This was due mainly to significantly more relapses after EF-RT only (arm A, 22%; arm B, 3%). No patient treated with CMT experienced relapse before year 3. Relapses were treated mainly with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, or with the combination cyclophosphamide, vincristine, procarbazine, and prednisone/ABVD; treatment of relapse was significantly more successful in arm A than in arm B (P = .017). In total, there were 39 second malignancies, with 21 in arm A and 18 in arm B, respectively. The incidence was approximately 0.8% per year during years 2 to 9 and was highest in older patients (P < .0001) and those with "B" symptoms (P = .012).


CONCLUSIONS
CMT consisting of two cycles of ABVD plus EF-RT is more effective than EF-RT alone.
Engert
Andreas
A
First Department of Internal Medicine, Coordination Center for Clinical Trials, and Department of Radiotherapy, University Hospital of Cologne, Cologne, Germany. a.engert@uni-koeln.de
Franklin
Jeremy
J
Eich
Hans Theodor
HT
Brillant
Corinne
C
Sehlen
Susanne
S
Cartoni
Claudio
C
Herrmann
Richard
R
Pfreundschuh
Michael
M
Sieber
Markus
M
Tesch
Hans
H
Franke
Astrid
A
Koch
Peter
P
de Wit
Maike
M
Paulus
Ursula
U
Hasenclever
Dirk
D
Loeffler
Markus
M
Müller
Rolf-Peter
RP
Müller-Hermelink
Hans Konrad
HK
Dühmke
Eckhart
E
Diehl
Volker
V
D000293:Adolescent; D000328:Adult; D000368:Aged; 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; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018787:Radiation Oncology / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use
D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin