title: ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma.
abstract: BACKGROUND
  Chemotherapy plus radiation treatment is effective in controlling stage IA or IIA nonbulky Hodgkin's lymphoma in 90% of patients but is associated with late treatment-related deaths. Chemotherapy alone may improve survival because it is associated with fewer late deaths.
  
  
  METHODS
  We randomly assigned 405 patients with previously untreated stage IA or IIA nonbulky Hodgkin's lymphoma to treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) alone or to treatment with subtotal nodal radiation therapy, with or without ABVD therapy. Patients in the ABVD-only group, both those with a favorable risk profile and those with an unfavorable risk profile, received four to six cycles of ABVD. Among those assigned to subtotal nodal radiation therapy, patients who had a favorable risk profile received subtotal nodal radiation therapy alone and patients with an unfavorable risk profile received two cycles of ABVD plus subtotal nodal radiation therapy. The primary end point was 12-year overall survival.
  
  
  RESULTS
  The median length of follow-up was 11.3 years. At 12 years, the rate of overall survival was 94% among those receiving ABVD alone, as compared with 87% among those receiving subtotal nodal radiation therapy (hazard ratio for death with ABVD alone, 0.50; 95% confidence interval [CI], 0.25 to 0.99; P=0.04); the rates of freedom from disease progression were 87% and 92% in the two groups, respectively (hazard ratio for disease progression, 1.91; 95% CI, 0.99 to 3.69; P=0.05); and the rates of event-free survival were 85% and 80%, respectively (hazard ratio for event, 0.88; 95% CI, 0.54 to 1.43; P=0.60). Among the patients randomly assigned to ABVD alone, 6 patients died from Hodgkin's lymphoma or an early treatment complication and 6 died from another cause; among those receiving radiation therapy, 4 deaths were related to Hodgkin's lymphoma or early toxic effects from the treatment and 20 were related to another cause.
  
  
  CONCLUSIONS
  Among patients with Hodgkin's lymphoma, ABVD therapy alone, as compared with treatment that included subtotal nodal radiation therapy, was associated with a higher rate of overall survival owing to a lower rate of death from other causes. (Funded by the Canadian Cancer Society and the National Cancer Institute; HD.6 ClinicalTrials.gov number, NCT00002561.).
authors.affiliation: Cancer Research Institute, Queen's University, Kingston, ON, Canada. rmeyer@ctg.queensu.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: Woodrow A
authors.initials: WA
authors.lastname: Wells
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: Chaim
authors.initials: C
authors.lastname: Shustik
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Stewart
authors.forename: Michael
authors.initials: M
authors.lastname: Crump
authors.forename: Marina S
authors.initials: MS
authors.lastname: Djurfeldt
authors.forename: Bingshu E
authors.initials: BE
authors.lastname: Chen
authors.forename: Lois E
authors.initials: LE
authors.lastname: Shepherd
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000401:mortality; D011878:Radiotherapy / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin