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. 1984 Jun;49(6):695–702. doi: 10.1038/bjc.1984.110

A randomised study of adjuvant chemotherapy after mantle radiotherapy in supradiaphragmatic Hodgkin's disease PS IA-IIB: a report from the Manchester lymphoma group.

H Anderson, D P Deakin, J Wagstaff, J M Jones, I D Todd, P M Wilkinson, R D James, W P Steward, G Blackledge, J H Scarffe, et al.
PMCID: PMC1976842  PMID: 6375711

Abstract

One hundred and fourteen untreated patients with pathological stage (PS) IA-IIB supradiaphragmatic Hodgkin's Disease were randomised to mantle radiotherapy alone (55) or mantle radiotherapy followed by 6 courses of adjuvant chemotherapy with mustine, vinblastine, prednisolone and procarbazine- MVPP (59). Patients excluded were those outside the age range 16-65 years and those with massive mediastinal disease precluding laparotomy. Bulk disease was defined as a mass of lymph nodes measuring five centimetres or more in any axis. Mediastinal bulk was present if the ratio of the maximum width of mediastinal disease to the maximal chest diameter was more than one third. All patients achieved a complete remission. Median duration of follow-up was 62 months (range 16-97). The relapse free survival (RFS) was 81%; 69% for radiotherapy alone and 93% for adjuvant chemotherapy (P = 0.002). RFS was also shown to be adversely affected by B symptoms (P = 0.0003), bulk disease (P = 0.018), abnormal CXR (P = 0.037), and increasing stage (P = 0.039). Age, sex, histology, and number of sites involved had no significant effect upon RFS. A Cox multivariate analysis showed that only three variables had a significant adverse effect on RFS - radiotherapy alone, the presence of bulk disease, and B symptoms. The overall 5 year survival was 93% with no statistically significant difference between the two treatment groups (P = 0.54). Survival was adversely affected by three variables - B symptoms (P = 0.02), the presence of bulk disease (P = 0.002), and pathological stage (P = 0.05). High risk groups for relapse are those with bulk and B symptoms. This analysis has shown that RFS was significantly improved by adjuvant chemotherapy, but that overall survival was not.

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Selected References

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  1. Aisenberg A. C. The staging and treatment of Hodgkin's disease. N Engl J Med. 1978 Nov 30;299(22):1228–1232. doi: 10.1056/NEJM197811302992206. [DOI] [PubMed] [Google Scholar]
  2. Andrieu J. M., Montagnon B., Asselain B., Bayle-Weisgerber C., Chastang C., Teillet F., Bernard J. Chemotherapy--radiotherapy association in Hodgkin's disease, clinical stages IA, II2A: results of a prospective clinical trial with 166 patients. Cancer. 1980 Nov 15;46(10):2126–2130. doi: 10.1002/1097-0142(19801115)46:10<2126::aid-cncr2820461003>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  3. Carbone P. P., Kaplan H. S., Musshoff K., Smithers D. W., Tubiana M. Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res. 1971 Nov;31(11):1860–1861. [PubMed] [Google Scholar]
  4. Carmel R. J., Kaplan H. S. Mantle irradiation in Hodgkin's disease. An analysis of technique, tumor eradication, and complications. Cancer. 1976 Jun;37(6):2813–2825. doi: 10.1002/1097-0142(197606)37:6<2813::aid-cncr2820370637>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  5. DeVita V. T., Jr, Simon R. M., Hubbard S. M., Young R. C., Berard C. W., Moxley J. H., 3rd, Frei E., 3rd, Carbone P. P., Canellos G. P. Curability of advanced Hodgkin's disease with chemotherapy. Long-term follow-up of MOPP-treated patients at the National Cancer Institute. Ann Intern Med. 1980 May;92(5):587–595. doi: 10.7326/0003-4819-92-5-587. [DOI] [PubMed] [Google Scholar]
  6. Devita V. T., Jr, Serpick A. A., Carbone P. P. Combination chemotherapy in the treatment of advanced Hodgkin's disease. Ann Intern Med. 1970 Dec;73(6):881–895. doi: 10.7326/0003-4819-73-6-881. [DOI] [PubMed] [Google Scholar]
  7. Hoppe R. T., Coleman C. N., Cox R. S., Rosenberg S. A., Kaplan H. S. The management of stage I--II Hodgkin's disease with irradiation alone or combined modality therapy: the Stanford experience. Blood. 1982 Mar;59(3):455–465. [PubMed] [Google Scholar]
  8. KAPLAN H. S. The radical radiotherapy of regionally localized Hodgkin's disease. Radiology. 1962 Apr;78:553–561. doi: 10.1148/78.4.553. [DOI] [PubMed] [Google Scholar]
  9. Kaplan H. S., Rosenberg S. A. The management of Hodgkin's disease. Cancer. 1975 Aug;36(2):796–803. doi: 10.1002/1097-0142(197508)36:2+<796::aid-cncr2820360825>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  10. Lee C. K., Bloomfield C. D., Goldman A. I., Levitt S. H. Prognostic significance of mediastinal involvement in Hodgkin's disease treated with curative radiotherapy. Cancer. 1980 Dec 1;46(11):2403–2409. doi: 10.1002/1097-0142(19801201)46:11<2403::aid-cncr2820461116>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  11. Lee C. K., Bloomfield C. D., Goldman A. I., Nesbit M. E., Levitt S. H. The therapeutic utility of lung irradiation for Hodgkin's disease patients with large mediastinal masses. Int J Radiat Oncol Biol Phys. 1981 Feb;7(2):151–154. doi: 10.1016/0360-3016(81)90430-2. [DOI] [PubMed] [Google Scholar]
  12. Mauch P., Goodman R., Hellman S. The significance of mediastinal involvement in early stage Hodgkin's disease. Cancer. 1978 Sep;42(3):1039–1045. doi: 10.1002/1097-0142(197809)42:3<1039::aid-cncr2820420302>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  13. Nissen N. I., Nordentoft A. M. Radiotherapy versus combined modality treatment of stage I and II Hodgkin's disease. Cancer Treat Rep. 1982 Apr;66(4):799–803. [PubMed] [Google Scholar]
  14. Peckham M. J., Ford H. T., McElwain T. J., Harmer C. L., Atkinson K., Austin D. E. The results of radiotherapy for Hodgkins' disease. Br J Cancer. 1975 Sep;32(3):391–400. doi: 10.1038/bjc.1975.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Portlock C. S., Rosenberg S. A., Glatstein E., Kaplan H. S. Impact of salvage treatment on initial relapses in patients with Hodgkin disease, stages I-III. Blood. 1978 May;51(5):825–833. [PubMed] [Google Scholar]
  16. Rosenberg S. A., Kaplan H. S. The management of stages I, II, and III Hodgkin's disease with combined radiotherapy and chemotherapy. Cancer. 1975 Jan;35(1):55–63. doi: 10.1002/1097-0142(197501)35:1<55::aid-cncr2820350108>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  17. Sutcliffe S. B., Wrigley P. F., Peto J., Lister T. A., Stansfeld A. G., Whitehouse J. M., Crowther D., Malpas J. S. MVPP chemotherapy regimen for advanced Hodgkin's disease. Br Med J. 1978 Mar 18;1(6114):679–683. doi: 10.1136/bmj.1.6114.679. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Teillet F., Delbrück H., Bayle-Weisgerber C., Asselain B., Lelièvre P., Bernard J. Möglichkeiten einer Therapiereduktion bei Morbus Hodgkin III. Kann die Polychemotherapie bei einer kombinierten Chemo-Strahlentherapie lokalisierter Stadien verringert werden? Dtsch Med Wochenschr. 1981 May 1;106(18):566–570. doi: 10.1055/s-2008-1070356. [DOI] [PubMed] [Google Scholar]
  19. Timothy A. R., Sutcliffe S. B., Stansfeld A. G., Wrigley P. F., Jones A. E. Radiotherapy in the treatment of Hodgkin's disease. Br Med J. 1978 May 13;1(6122):1246–1249. doi: 10.1136/bmj.1.6122.1246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Timothy A. R., Sutcliffe S. B., Wrigley P. F., Jones A. E. Hodgkin's disease: combination chemotherapy for relapse following radical radiotherapy. Int J Radiat Oncol Biol Phys. 1979 Feb;5(2):165–169. doi: 10.1016/0360-3016(79)90715-6. [DOI] [PubMed] [Google Scholar]
  21. Torti F. M., Portlock C. S., Rosenberg S. A., Kaplan H. S. Extralymphatic Hodgkin's disease. Prognosis and response to therapy. Am J Med. 1981 Mar;70(3):487–492. doi: 10.1016/0002-9343(81)90570-2. [DOI] [PubMed] [Google Scholar]
  22. Wiernik P. H., Gustafson J., Schimpff S. C., Diggs C. Combined modality treatment of Hodgkin's disease confined to lymph nodes. Results eight years later. Am J Med. 1979 Aug;67(2):183–198. doi: 10.1016/0002-9343(79)90389-9. [DOI] [PubMed] [Google Scholar]

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