LUGANO, SwitzerlandThe impact of radiotherapy on disease
control and toxicity in patients with advanced Hodgkins disease
remains controversial. In fact, a 1998 meta-analysis suggested that
combined-modality therapy results in worse long-term survival than
does chemotherapy alone.
Now, preliminary results from a randomized multicenter study
performed by the French Adult Lymphoma Study Group (GELA) confirm
that extended-field irradiation confers no additional survival
advantage over chemotherapy by itself. The trial results were
reported at the VII International Conference on Malignant Lymphoma.
The GELA investigators randomly assigned 559 patients with untreated
stage IIIB/IV Hodgkins disease to receive, as induction
chemotherapy, six cycles of either ABVPP (Adriamycin [doxorubicin],
bleomycin, vinblastine, procarba-zine, and prednisone) or a MOPP/ABV
hybrid (mechlorethamine, Oncovin [vincristine], procarbazine, and
prednisone plus Adriamycin, bleomycin, vindesine).
Next, the 418 patients who achieved complete or partial remission
were randomized to consolidation therapy with either two additional
cycles of the same chemotherapy regimen or total nodal irradiation
with 30 Gy plus 5 Gy for initially involved areas plus 5 Gy for
Intention-to-treat analysis after 48 months of follow-up revealed no
significant differences in event-free survival between the two
induction regimens or the two consolidation regimens, or among the
four treatment groups, observed Christophe Fermé, MD, of the
Hematology Institute, Saint-Louis Hospital, Paris.
However, Dr. Fermé stressed, overall
survival was significantly superior in patients who received ABVPP
alone than in those treated with ABVPP plus extended-field
irradiation (94% vs 78%). After ABVPP and radiotherapy, the
risk of death was four times higher than after ABVPP alone, he said.
In contrast, no survival differences emerged between MOPP/ABV alone
and MOPP/ABV followed by radiotherapy.
These results suggest an interaction between the induction
regimen and consolidation regimen, Dr. Fermé noted.
A Standard Regimen
Interestingly, the number of relapses was higher and the duration of
complete response was shorter among patients assigned to chemotherapy
alone than among those who received combined-modality therapy.
Nonetheless, the results suggested a tendency toward a lower number
of deaths attributable to Hodgkins disease among patients
treated with chemotherapy alone.
Eight cycles of a conventional-dose doxorubicin-containing
regimen can be a standard regimen if a complete response has been
achieved after six cycles, Dr. Fermé advised. Before
specific indications for adjuvant radiotherapy can be defined, he
said, analyses of fatalities, results of salvage therapy, and
long-term toxicity will be necessary.