Nov. 13, 2001
     Lymphoma Cancer

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Chemo-radiation improves early-stage Hodgkin's disease

SEATTLE -- 13 Nov. 2001 -- 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, according to a large United States multi-center trial.

The study -- the largest randomized trial of early-stage Hodgkin's disease conducted in the U.S. in two decades -- evaluated whether chemotherapy should be part of the treatment regimen for patients with a early-stage blood cancer called Hodgkin's disease.

The large collaborative study led by Dr. Oliver Press of the University of Washington was published in the Nov. 15 issue of the Journal of Clinical Oncology.

"Patients receiving this novel chemotherapy regimen followed by radiation achieved a marked improvement in failure free survival rates compared with patients treated with radiation therapy alone," said Press in a prepared statement. "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."

Earlier studies using other chemotherapy combinations followed by radiation also demonstrated improved progression-free survival rates; but patients experienced excessive toxic side effects.

The study also determined that staging laparotomy -- a previously common abdominal surgery used to diagnose the stage of Hodgkin's disease -- could be avoided. Instead of undergoing staging laparotomy, patients in the trial were staged clinically, by examining tumor size, lymph node involvement, and where the disease has spread.

In the large 10-year trial involving 348 patients who had not undergone staging laparotomy, half were randomly assigned to treatment with either a combined treatment of three cycles of a combination of chemotherapy agents doxorubicin and vinblastine followed by radiation, the other half were treated with radiation alone. Radiation therapy levels were the same for patients in both arms.

Of the patients who received the combined treatment, 94 percent survived three years with no return of the cancer or any other treatment-related complications. That compared to 81 percent of patients who received only radiation therapy. Because of the significant results, the study was stopped at the second interim analysis after nine years.

Ten patients experienced disease progression in the combined treatment group compared to 34 on the radiation-only therapy group, and only one treatment-related death occurred on each arm. Because highly toxic chemotherapy drugs were not used, patients generally experienced manageable side effects.

During the last three to four years, combined treatment regimens of short course chemotherapy followed by radiation such as the one used in this trial have become the standard of care for patients with early-stage Hodgkin's disease. Today, most physicians use even smaller radiation fields than were used in this study.