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(Drug information on doxorubicin) and vinblastine(Drug information on 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.