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Novel Chemoradiation Regimen Improves Outlook in Early-Stage Hodgkin’s Disease

Novel Chemoradiation Regimen Improves Outlook in Early-Stage Hodgkin’s Disease

A study conducted by the Southwest Oncology Group
reported that a short course of chemotherapy followed by radiation significantly
improves time to disease progression and minimizes toxicity in patients with
early-stage Hodgkin’s disease. The study evaluated whether chemotherapy should
be part of the treatment regimen for patients with early-stage Hodgkin’s
disease. Earlier studies of other chemotherapy combinations followed by
radiation also demonstrated improved progression-free survival rates; however,
patients experienced excessive toxicities.

In addition, the study determined that staging laparotomy could be avoided in
this setting. The 348 patients enrolled in the 10-year phase III trial were
staged clinically, by examining tumor size, lymph node involvement, and
metastatic sites. Patients were then randomized to receive either a combined
treatment of three cycles of doxorubicin and vinblastine followed by radiation,
or radiation alone. Radiation therapy levels were the same for patients in both
arms of the investigation.

Favorable Results Halt Study

Among patients who received the combined treatment, the 3-year failure-free
survival rate was 94%, compared to 81% for the radiation therapy-only arm.
Patients who achieved failure-free survival did not experience a recurrence of
disease or develop any other treatment-related complications during the 3-year
follow-up period. Because of these significant results, the study was stopped at
the second interim analysis after 9 years. The results were reported in a
recent issue of the Journal of Clinical Oncology (19:4238-4244, 2001).

"Patients receiving this novel chemotherapy regimen followed by
radiation achieved a marked improvement in failure-free rates compared with
patients treated with radiation therapy alone," said lead author Oliver
Press, md, professor of medicine in the division of medical oncology at the
University of Washington. "This study also showed that staging laparotomy
was not necessary to obtain excellent failure-free survival rates for patients
with early-stage Hodgkin’s disease."

Manageable Side Effects

In the combined treatment arm, 10 patients experienced disease progression
compared to 34 in the radiation therapy-only arm, and one treatment-related
death occurred in each arm. Because highly toxic chemotherapy agents were not
used, side effects were generally manageable.

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