ALTERNATING MOPP AND ABVD CHEMOTHERAPY PLUS MANTLE-FIELD RADIATION-THERAPY IN PATIENTS WITH MASSIVE MEDIASTINAL HODGKINS-DISEASE

Purpose: To evaluate Pine efficacy and toxicity of mechlorethamine, vi ncristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy plus mantle-field ra diation therapy in the treatment of patients with massive mediastinal Hodgkin's disease of any stage. Patients and Methods: Eighty patients presented with Hodgkin's disease and a mediastinal mass greater than o ne third the greatest chest diameter on chest radiograph. Patients wer e staged and treated with MOPP alternated with ABVD chemotherapy for a total of six cycles. patients then received 10 Gy mantle-field radiat ion therapy delivered to the original extent of disease followed by 25 to 35 Gy to the residual abnormalities. Results: The complete respons e (CR) rate was 89%, With a median follow-up duration of 10 years, dis ease-free survives of the complete responders is 78% at 15 )rears and overall survival is 75% at 15 years, For patients with stage I or II d isease, disease-free survival was 76% at 15 years and overall survival was 79%; for those with stage III or IV disease, disease-free surviva l was 82% at 15 years and overall survival was 64%. age, stage, sew, B symptoms, number of extranodal sites, lactate dehydrogenase (LDH) lev els, erythrocyte sedimentation rate, and platelet count did net influe nce treatment outcome, Treatment-related pneumonitis was noted in 16% of patients (fatal in one), mainly in those alder than age 35 years wh o received total doses of radiation therapy greater than 42 Gy, Fertil ity is more often preserved with MOPP/ABVD therapy than with MOPP chem otherapy and there appears to be less pulmonary and cardiac disease th an with ABVD chemortherapy, Two patients have developed second solid t umors within radiation ports and one relapsed patient developed acute leukemia after MOPP salvage therapy. Conclusion: MOPP/ABVD followed by mantle-field radiation therapy is an effective treatment for all stag es of Hodgkin's disease that present with a large mediastinal mass, Ou r data suggest that the large mediastinal mass is a more dominant dete rminant of prognosis than Ann arbor stage or other clinical prognostic factors.