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Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma

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Official URL:https://doi.org/10.1056/NEJMoa1000067
PubMed:View item in PubMed
Creators Name:Engert, A. and Pluetschow, A. and Eich, H.T. and Lohri, A. and Doerken, B. and Borchmann, P. and Berger, B. and Greil, R. and Willborn, K.C. and Wilhelm, M. and Debus, J. and Eble, M.J. and Soekler, M. and Ho, A. and Rank, A. and Ganser, A. and Truemper, L. and Bokemeyer, C. and Kirchner, H. and Schubert, J. and Kral, Z. and Fuchs, M. and Mueller-Hermelink, H.K. and Mueller, R.P. and Diehl, V.
Journal Title:New England Journal of Medicine
Journal Abbreviation:N Engl J Med
Page Range:640-652
Date:12 August 2010
Keywords:Positron Emission Tomography, Involved Field Radiotherapy, Combined Modality Therapy, Randomized Trials, Radiation Therapy, Prognostic Score, Disease Patients, 2nd Malignancy, Clinical Trial, 2 Cyles
Abstract:BACKGROUND: Whether it is possible to reduce the intensity of treatment in early (stage I or II) Hodgkin's lymphoma with a favorable prognosis remains unclear. We therefore conducted a multicenter, randomized trial comparing four treatment groups consisting of a combination chemotherapy regimen of two different intensities followed by involved-field radiation therapy at two different dose levels. METHODS: We randomly assigned 1370 patients with newly diagnosed early-stage Hodgkin's lymphoma with a favorable prognosis to one of four treatment groups: four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy of radiation therapy (group 1), four cycles of ABVD followed by 20 Gy of radiation therapy (group 2), two cycles of ABVD followed by 30 Gy of radiation therapy (group 3), or two cycles of ABVD followed by 20 Gy of radiation therapy (group 4). The primary end point was freedom from treatment failure; secondary end points included efficacy and toxicity of treatment. RESULTS: The two chemotherapy regimens did not differ significantly with respect to freedom from treatment failure (P = 0.39) or overall survival (P = 0.61). At 5 years, the rates of freedom from treatment failure were 93.0% (95% confidence interval [CI], 90.5 to 94.8) with the four-cycle ABVD regimen and 91.1% (95% CI, 88.3 to 93.2) with the two-cycle regimen. When the effects of 20-Gy and 30-Gy doses of radiation therapy were compared, there were also no significant differences in freedom from treatment failure (P = 1.00) or overall survival (P = 0.61). Adverse events and acute toxic effects of treatment were most common in the patients who received four cycles of ABVD and 30 Gy of radiation therapy (group 1). CONCLUSIONS: In patients with early-stage Hodgkin's lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy is as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy. Long-term effects of these treatments have not yet been fully assessed. (Funded by the Deutsche Krebshilfe and the Swiss Federal Government; ClinicalTrials.gov number, NCT00265018.)
Publisher:Massachusetts Medical Society (U.S.A.)
Item Type:Article

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