Patients with early-stage Hodgkin's disease have better outcomes when chemotherapy is followed by involved-field radiotherapy rather than subtotal nodal radiotherapy, physicians in Europe report, which applies to patients with favorable or unfavorable characteristics.
Dr. Christophe Ferme and colleagues reviewed the outcomes of 1,538 patients with untreated stage I or II supradiaphragmatic Hodgkin's disease who were treated between 1993 and 1999. On the basis of initial clinical and biologic features, 542 were classified as having a favorable prognosis and 996 as having an unfavorable prognosis.
Patients with favorable features were randomized to subtotal nodal radiotherapy or three cycles of chemotherapy plus involved-field radiotherapy. Those with unfavorable features were randomized to four or six cycles of chemotherapy plus involved field radiotherapy or subtotal nodal radiotherapy.
Chemotherapy consisted of MOPP-ABV (mechlorethamine, vincristine, procarbazine, prednisone -- doxorubicin, bleomycin and vinblastine). Median follow-up was 92 months.
In the group with favorable features, five-year event-free survival was significantly greater after treatment with three cycles of MOPP-ABV plus involved-field radiotherapy than after subtotal nodal radiotherapy alone (98 versus 74 per cent, p < 0.001). Estimated ten-year overall survival rates were 97 and 92 per cent, respectively, (p = 0.001).
In the group with unfavorable features, five-year event-free survival and estimates of ten-year overall survival were similar in all treatment groups and for each time period, ranging from 84 to 88 per cent.
Dr. Ferme's group recommends that for patients with early-stage Hodgkin's disease, "chemotherapy plus involved-field radiotherapy should be the standard treatment." They further advise that chemotherapy be limited to four cycles in patients, even in those with unfavorable features, to minimize treatment side effects.
In a related editorial, Dr. Volker Diehl, at the University of Cologne in Germany, points out that the MOPP-ABV regimen has been replaced with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) for patients with early-stage disease to avoid the long-term increased risk of other cancers.
With the advent of a sensitive metabolic imaging technique -- positron-emission tomography with F-18-fluorodeoxyglucose (PET-FDG) with computed tomography -- to follow patients' response to treatment, some may also be spared prolonged chemotherapy or radiotherapy
