Two Cycles ABVD Plus Extended Field Radiotherapy Is Superior to Radiotherapy Alone in Early Stage Hodgkin's Disease: Results of the German Hodgkin's Lymphoma Study Group (GHSG) Trial HD7
Reviewer: Walter Sall, MD
Last Modified: December 9, 2002
Presenter: Markus Sieber
Presenter's Affiliation: University of Cologne
Type of Session: Scientific
- Extended Field (EF)Radiotherapy alone has been considered the standard for early stage Hodgkin's Disease (HD) with 90% 10 year Overall Survival (OS).
- However, 20-25% of these patients suffer a relapse requiring intensive salvage chemotherapy.
- The aim of this trial was to analyze whether the addition of 2 cycles of ABVD prior to EF RT would decrease relapse risk without appreciable increase in treatment toxicity.
Materials and Methods
- From Feb., 1994 to March, 1998 627 patients were randomized of whom 617 were evaluable.
- Eligible patients had Stage I or II, A or B disease without any of the following risk factors; bulky disease, extranodal disease, increased ESR, or > 2 involved nodal areas.
- Group A received 30Gy EF RT + 10Gy involved field boost. Group B received 2 cycles ABVD followed by the same radiotherapy as arm A.
- Groups were well balanced by all demographic factors. 6% had B symptoms, 56% were stage I and 44% were stage II.
- Median follow-up was 60 months.
- A Complete Response (CR) was obtained in 96% of group A patients vs. 95% of group B.
- 5 year freedom from failure (FFF) was 75% in group A vs. 90% in Group B (p<0.05).
- 5 year OS was 94% in both groups.
- In both groups, approximately 1/3 of recurrences were in field, 1/3 were out of field and the remaining 1/3 were in and out of field.
- Acute WHO grade III/IV toxicities were very rare in both groups with greater incidence of alopecia and minor nausea and leukopenia in the combined modality group as expected.
- Two cycles of ABVD prior to EF RT is better than EF RT alone in the treatment of stage I/II HD.
- Chemotherapy improved FFF rates with low toxicity and no demonstrated increased risk of secondary malignancies.
- Based on this trial, combined modality therapy is now considered the standard of care in Germany.
- The optimum chemotherapy regimen, as well as the optimum radiation field size and dose remains to be defined.
Historically, EF RT has been the treatment of choice for localized HD. The desire to improve cure rates even further has led to trials involving combination chemotherapy and radiation. This trial shows that the addition of chemotherapy to standard radiation can improve outcomes with acceptably low increases in short and long term toxicity. Today, combination chemotherapy with lower dose involved field radiation has become increasingly popular. Further trials will be needed to determine whether chemotherapy will allow more limited radiation to be used without a corresponding increase in failure rates.
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