Topics:

Involved-Field RT Is Effective in Hodgkin’s Disease

Involved-Field RT Is Effective in Hodgkin’s Disease

ORLANDO—European researchers have found involved-field and extended-field
radiotherapy following chemotherapy to be equally effective in treating
patients with intermediate-stage Hodgkin’s disease. Andreas Engert, MD,
University of Cologne, Germany, reported the results of the multicenter,
international study at the 43rd Annual Meeting of the American Society of
Hematology (abstract 3199).

The findings are the final analysis of the HD8 trial of the German Hodgkin’s
Lymphoma Study Group (GHSG). More than 8,500 patients have been enrolled in
GHSG since its inception more than 20 years ago. Dr. Engert said that half of
all German patients with Hodgkin’s disease are enrolled in a clinical trial
and an additional 45% are treated according to trial protocols by their
physicians.

At the time the HD8 trial began in the early- to mid-1990s, the standard
protocol for patients with intermediate-stage Hodgkin’s disease included four
cycles of chemotherapy followed by extended-field radiation.

"The problem was the high toxicity with the larger field, including
second malignancies turning up later in the course of the disease," Dr.
Engert said. Prior GHSG trials found 20 Gy, 30 Gy, and 40 Gy extended-field
radiotherapy to be equally effective, given after two double cycles of
COPP-ABVD chemotherapy. "The question then arose," he said, "‘Is
it necessary at all to have a large, extended field?’"

The researchers randomized 1,136 patients to receive two double cycles of
COPP/ABVD and either 30 Gy extended-field plus 10 Gy bulk radiotherapy or 30 Gy
involved-field plus 10 Gy bulk radiotherapy.

Due to death, progression, toxicity, and other reasons, 70 patients dropped
out before radiotherapy began, leaving 533 in each cohort. Patients were
equally balanced by age, sex, and disease stage. "There were substantially
more acute toxicities in the extended-field group," Dr. Engert said.
Toxicities more common in the extended-field patients included leukopenia,
thrombocytopenia, nausea, and pharynx and stomach distress.

"Response was the crucial question," he said. "Could a
smaller field be equally effective?" Results showed no difference in
complete and partial response between the two cohorts, and no significant
difference in progressive disease. With a median follow-up of 5 years, the
groups showed no difference in survival: 91.2% in the extended-field group and
93.8% in the involved-field group.

Pages

 
Loading comments...
Please Wait 20 seconds or click here to close