Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease.
BACKGROUND
Treatment of early-stage Hodgkin's disease is usually tailored in line with prognostic factors that allow for reductions in the amount of chemotherapy and extent of radiotherapy required for a possible cure.


METHODS
From 1993 to 1999, we identified 1538 patients (age, 15 to 70 years) who had untreated stage I or II supradiaphragmatic Hodgkin's disease with favorable prognostic features (the H8-F trial) or unfavorable features (the H8-U trial). In the H8-F trial, we compared three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) combined with doxorubicin, bleomycin, and vinblastine (ABV) plus involved-field radiotherapy with subtotal nodal radiotherapy alone (reference group). In the H8-U trial, we compared three regimens: six cycles of MOPP-ABV plus involved-field radiotherapy (reference group), four cycles of MOPP-ABV plus involved-field radiotherapy, and four cycles of MOPP-ABV plus subtotal nodal radiotherapy.


RESULTS
The median follow-up was 92 months. In the H8-F trial, the estimated 5-year event-free survival rate was significantly higher after three cycles of MOPP-ABV plus involved-field radiotherapy than after subtotal nodal radiotherapy alone (98% vs. 74%, P<0.001). The 10-year overall survival estimates were 97% and 92%, respectively (P=0.001). In the H8-U trial, the estimated 5-year event-free survival rates were similar in the three treatment groups: 84% after six cycles of MOPP-ABV plus involved-field radiotherapy, 88% after four cycles of MOPP-ABV plus involved-field radiotherapy, and 87% after four cycles of MOPP-ABV plus subtotal nodal radiotherapy. The 10-year overall survival estimates were 88%, 85%, and 84%, respectively.


CONCLUSIONS
Chemotherapy plus involved-field radiotherapy should be the standard treatment for Hodgkin's disease with favorable prognostic features. In patients with unfavorable features, four courses of chemotherapy plus involved-field radiotherapy should be the standard treatment. (ClinicalTrials.gov number, NCT00379041 [ClinicalTrials.gov].).
Fermé
Christophe
C
Department of Medicine, Institut de Cancérologie Gustave Roussy, Villejuif, France. christophe.ferme@igr.fr
Eghbali
Houchingue
H
Meerwaldt
Jacobus H
JH
Rieux
Chantal
C
Bosq
Jacques
J
Berger
Françoise
F
Girinsky
Théodore
T
Brice
Pauline
P
van't Veer
Mars B
MB
Walewski
Jan A
JA
Lederlin
Pierre
P
Tirelli
Umberto
U
Carde
Patrice
P
Van den Neste
Eric
E
Gyan
Emmanuel
E
Monconduit
Mathieu
M
Diviné
Marine
M
Raemaekers
John M M
JM
Salles
Gilles
G
Noordijk
Evert M
EM
Creemers
Geert-Jan
GJ
Gabarre
Jean
J
Hagenbeek
Anton
A
Reman
Oumédaly
O
Blanc
Michel
M
Thomas
José
J
Vié
Brigitte
B
Kluin-Nelemans
Johanna C
JC
Viseu
Fernando
F
Baars
Joke W
JW
Poortmans
Philip
P
Lugtenburg
Pieternella J
PJ
Carrie
Christian
C
Jaubert
Jérôme
J
Henry-Amar
Michel
M
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; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D015182:Lymphatic Irradiation; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011878:Radiotherapy / Q000009:adverse effects; 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