89976
document
Dose-response relationship of complementary radiotherapy following four cycles of combination chemotherapy in intermediate-stage Hodgkin 's disease . PURPOSE To determine the appropriate irradiation dose after four cycles of modern combination chemotherapy in nonbulky involved field ( IF/BF ) and noninvolved extended-field ( EF/IF ) sites in patients with intermediate-stage Hodgkin 's disease ( HD ) . MATERIALS AND METHODS HD patients in stage I to IIIA with a large mediastinal mass , E stage , or massive spleen involvement were treated with two double cycles of alternating cyclophosphamide , vincristine , procarbazine , and prednisone ( COPP ) plus doxorubicin , bleomycin , vinblastine , and dacarbazine ( ABVD ) followed by EF irradiation in two successive trials ( HD1 and HD5 ) . In the HD1 trial ( 1983 to 1988 ) , 146 patients who responded to chemotherapy were randomized to receive 20 Gy ( 70 patients ) or 40 Gy ( 76 patients ) of EF irradiation in all fields outside bulky disease sites . A cohort of 111 patients who fulfilled the same inclusion criteria in the subsequent trial HD5 ( 1988 to 1993 ) were treated with 30 Gy . Bulky disease always received 40 Gy . RESULTS Freedom-from-treatment-failure ( FFTF ) and survival ( SV ) curves showed no differences between the 20- , 30- , and 40-Gy groups . However , acute toxicities were more frequent in the 40-Gy arm . Analysis of relapse patterns showed that 18 of 26 relapsing patients either failed to respond in initial bulky sites ( n = 5 ) or had an extranodal relapse ( n = 9 ) or both ( n = 4 ) . After 5 years , the cumulative risk for relapse in bulky sites is 10 % , despite 40 Gy of radiation . CONCLUSION Our results strongly suggest that there is no relevant radiotherapy dose effect in the range between 20 Gy and 40 Gy in IF/BF and EF/IF after 4 months of modern polychemotherapy in patients with intermediate-stage HD . Relapse patterns indicate that patients destined to relapse need more systemic , rather than local , treatment . Based on our data , we conclude that 20 Gy is sufficient in EF/IF of intermediate-stage HD following four cycles of modern polychemotherapy .
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Intervention_Physical
radiotherapy
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Intervention_Physical
chemotherapy
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Intervention_Physical
modern combination chemotherapy
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Intervention_Pharmacological
cyclophosphamide
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Intervention_Pharmacological
vincristine
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Intervention_Pharmacological
procarbazine
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Intervention_Pharmacological
prednisone ( COPP ) plus doxorubicin
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Intervention_Pharmacological
bleomycin
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Intervention_Pharmacological
vinblastine
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Intervention_Pharmacological
dacarbazine ( ABVD )
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Intervention_Physical
EF irradiation
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Intervention_Physical
radiation
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Intervention_Physical
radiotherapy
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Intervention_Physical
polychemotherapy
89991
Intervention_Physical
polychemotherapy
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Outcome_Physical
Freedom-from-treatment-failure ( FFTF )
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Outcome_Mortality
survival ( SV ) curves
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Outcome_Physical
acute toxicities
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Outcome_Physical
Analysis of relapse patterns
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Outcome_Physical
risk for relapse
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Outcome_Physical
radiotherapy dose effect
89998
Participant_Condition
Hodgkin 's disease
89999
Participant_Condition
chemotherapy
90000
Participant_Condition
Hodgkin 's disease
90001
Participant_Condition
HD
90002
Participant_Condition
HD
90003
Participant_Condition
stage I to IIIA
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Participant_Condition
large mediastinal mass
90005
Participant_Condition
E stage
90006
Participant_Condition
massive spleen involvement
90007
Participant_Sample-size
146
90008
Participant_Condition
chemotherapy
90009
Participant_Sample-size
70
90010
Participant_Sample-size
76
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Participant_Sample-size
111
90012
Participant_Condition
polychemotherapy
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Participant_Condition
intermediate-stage HD