title: Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease.
abstract: 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].).
authors.affiliation: Department of Medicine, Institut de Cancérologie Gustave Roussy, Villejuif, France. christophe.ferme@igr.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermé
authors.forename: Houchingue
authors.initials: H
authors.lastname: Eghbali
authors.forename: Jacobus H
authors.initials: JH
authors.lastname: Meerwaldt
authors.forename: Chantal
authors.initials: C
authors.lastname: Rieux
authors.forename: Jacques
authors.initials: J
authors.lastname: Bosq
authors.forename: Françoise
authors.initials: F
authors.lastname: Berger
authors.forename: Théodore
authors.initials: T
authors.lastname: Girinsky
authors.forename: Pauline
authors.initials: P
authors.lastname: Brice
authors.forename: Mars B
authors.initials: MB
authors.lastname: van't Veer
authors.forename: Jan A
authors.initials: JA
authors.lastname: Walewski
authors.forename: Pierre
authors.initials: P
authors.lastname: Lederlin
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
authors.forename: Patrice
authors.initials: P
authors.lastname: Carde
authors.forename: Eric
authors.initials: E
authors.lastname: Van den Neste
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gyan
authors.forename: Mathieu
authors.initials: M
authors.lastname: Monconduit
authors.forename: Marine
authors.initials: M
authors.lastname: Diviné
authors.forename: John M M
authors.initials: JM
authors.lastname: Raemaekers
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
authors.forename: Evert M
authors.initials: EM
authors.lastname: Noordijk
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Creemers
authors.forename: Jean
authors.initials: J
authors.lastname: Gabarre
authors.forename: Anton
authors.initials: A
authors.lastname: Hagenbeek
authors.forename: Oumédaly
authors.initials: O
authors.lastname: Reman
authors.forename: Michel
authors.initials: M
authors.lastname: Blanc
authors.forename: José
authors.initials: J
authors.lastname: Thomas
authors.forename: Brigitte
authors.initials: B
authors.lastname: Vié
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Kluin-Nelemans
authors.forename: Fernando
authors.initials: F
authors.lastname: Viseu
authors.forename: Joke W
authors.initials: JW
authors.lastname: Baars
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.forename: Pieternella J
authors.initials: PJ
authors.lastname: Lugtenburg
authors.forename: Christian
authors.initials: C
authors.lastname: Carrie
authors.forename: Jérôme
authors.initials: J
authors.lastname: Jaubert
authors.forename: Michel
authors.initials: M
authors.lastname: Henry-Amar
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; 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
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D004317:Doxorubicin; D011241:Prednisone