Commentary on Abstracts #2001 and #2000

The role of combined-modality therapy for Hodgkin’s disease was the subject of several abstracts presented at the ASH meeting. Radiation therapy has traditionally been the standard approach for patients with early-stage disease. However, several recent studies have suggested an important role for chemotherapy, either alone or in combination with radiation.

The German Hodgkin’s Study Group (Tesch et al, abstract #2001) treated low-risk patients with stage I or II disease with either extended-field radiation therapy alone or extended-field radiation therapy preceded by two cycles of ABVD. Freedom from treatment failure significantly favored the combined-modality approach.

This study complements an ongoing US trial led by the Southwest Oncology Group (SWOG), in which patients with low-risk early-stage disease are receiving total-lymphoid irradiation alone or combined with doxorubicin and vinblastine.

Benefit from consolidative radiation therapy in patients with advanced-stage Hodgkin’s disease has been more difficult to demonstrate. Fermé et al (abstract #2000) randomized 559 patients to either ABVPP or MOPP/ABV, with complete responders undergoing a secondary randomization to either two courses of additional chemotherapy or radiation therapy. These researchers were unable to detect an improvement in outcome. The median follow-up was only 46 months, and more long-term complications will likely be encountered.