Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group.

Abstract

PURPOSE:

We report results of a randomized trial comparing ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy alone with treatment that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma.

PATIENTS AND METHODS:

Patients with nonbulky clinical stage I to IIA Hodgkin's lymphoma were stratified into favorable and unfavorable risk cohorts. Patients allocated to radiation-containing therapy received subtotal nodal radiation if favorable risk or combined-modality therapy if unfavorable risk. Patients allocated to ABVD received four to six treatment cycles.

RESULTS:

We evaluated 399 patients. Median follow-up is 4.2 years. In comparison with ABVD alone, 5-year freedom from disease progression is superior in patients allocated to radiation therapy (P = .006; 93% v 87%); no differences in event-free survival (P = .06; 88% v 86%) or overall survival (P = .4; 94% v 96%) were detected. In a subset analyses comparing patients stratified into the unfavorable cohort, freedom from disease progression was superior in patients allocated to combined-modality treatment (P = .004; 95% v 88%); no difference in overall survival was detected (P = .3; 92% v 95%). Of 15 deaths observed, nine were attributed to causes other than Hodgkin's lymphoma or acute treatment-related toxicity.

CONCLUSION:

In patients with limited-stage Hodgkin's lymphoma, no difference in overall survival was detected between patients randomly assigned to receive treatment that includes radiation therapy or ABVD alone. Although 5-year freedom from disease progression was superior in patients receiving radiation therapy, this advantage is offset by deaths due to causes other than progressive Hodgkin's lymphoma or acute treatment-related toxicity.

• Authors: Ralph M Meyer, Mary K Gospodarowicz, Joseph M Connors, Robert G Pearcey, Andrea Bezjak, Woodrow A Wells, Bruce F Burns, Jane N Winter, Sandra J Horning, A Rashid Dar, Marina S Djurfeldt, Keyue Ding, Lois E Shepherd, National Cancer Institute of Canada Clinical Trials Group, Eastern Cooperative Oncology Group
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 23 Issue 21 Pg. 4634-42 (Jul 20 2005) ISSN: 0732-183X [Print] United States
• PMID: 15837968 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Bleomycin
• Vinblastine
• Dacarbazine
• Doxorubicin

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bleomycin (therapeutic use)
• Combined Modality Therapy
• Dacarbazine (therapeutic use)
• Disease-Free Survival
• Doxorubicin (therapeutic use)
• Female
• Follow-Up Studies
• Hodgkin Disease (mortality, therapy)
• Humans
• Male
• Survival Rate
• Vinblastine (therapeutic use)