Combination chemotherapy plus low-dose involved-field radiotherapy for early clinical stage Hodgkin's lymphoma

• Published in: International journal of radiation oncology, biology, physics Vol. 59; no. 3; p. 765
• Main Authors: Vassilakopoulos, Theodoros P, Angelopoulou, Maria K, Siakantaris, Marina P, Kontopidou, Flora N, Dimopoulou, Maria N, Kokoris, Styliani I, Kyrtsonis, Marie Christine, Tsaftaridis, Panayiotis, Karkantaris, Christos, Anargyrou, Konstantinos, Boutsis, Dimitrios E, Variamis, Eleni, Michalopoulos, Thymios, Boussiotis, Vassiliki A, Panayiotidis, Panayiotis, Papavassiliou, Constantinos, Pangalis, Gerassimos A
• Format: Journal Article
• Language: English
• Published: United States 01-07-2004
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin - administration & dosage; Combined Modality Therapy; Dacarbazine - administration & dosage; Disease-Free Survival; Doxorubicin - administration & dosage; Epirubicin - administration & dosage; Female; Hodgkin Disease - drug therapy; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Humans; Male; Mechlorethamine - administration & dosage; Middle Aged; Neoplasm Staging; Neoplasms, Second Primary - etiology; Prednisone - administration & dosage; Procarbazine - administration & dosage; Prognosis; Radiotherapy Dosage; Recurrence; Remission Induction; Treatment Outcome; Vinblastine - administration & dosage; Vincristine - administration & dosage
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2003.11.029

To present our long-term experience regarding the use of chemotherapy plus low-dose involved-field radiotherapy (IFRT) for clinical Stage I-IIA Hodgkin's lymphoma.
We analyzed the data of 368 patients. Of these, 66 received mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and 302 received doxorubicin (or epirubicin), bleomycin, vinblastine, and dacarbazine [A(E)BVD]. Patients with complete remission or very good partial remission were scheduled for low-dose IFRT (< or =3200 cGy).
The 10-year failure-free survival (FFS) and overall survival (OS) rate was 85% and 86%, respectively. A(E)BVD-treated patients had superior 10-year FFS and OS rates compared with MOPP-treated patients (87% vs. 75%, p = 0.009; and 93% vs. 71%, p = 0.0004, respectively). Only 10 of 41 relapses had any infield (irradiated) component. Of the complete responders/very good partial responders treated with low-dose IFRT, those who received <2800 cGy had inferior FFS but similar OS as those who received 2800-3200 cGy. Adverse prognostic factors for FFS included age > or =45 years, leukocytosis > or =10 x 10(9)/L, and extranodal extension. Secondary acute leukemia developed after MOPP with or without salvage therapy (n = 6) or after ABVD plus salvage therapy (n = 2). None of the nine secondary solid tumors developed within the RT fields.
IFRT at a dose of 2800-3000 cGy is highly effective in clinical Stage I-IIA HL patients who achieved a complete response or very good partial response with A(E)BVD. The long-term toxicity with respect to secondary malignancies appears to be acceptable.