VINBLASTINE, BLEOMYCIN, AND METHOTREXATE CHEMOTHERAPY PLUS EXTENDED-FIELD RADIOTHERAPY IN EARLY, FAVORABLY PRESENTING, CLINICALLY STAGED HODGKINS PATIENTS - THE GRUPPO-ITALIANO-PER-LO-STUDIO-DEI-LINFOMI EXPERIENCE

Purpose: To ascertain whether vinblastine, bleomycin, and methotrexate (VBM) (CT) combined with extended-field radiotherapy (EF RT) is effec tive enough to spare laparotomy in early, favorably presenting Hodgkin 's disease (HD) patients. Patients and Methods: Fifty patients with cl inical stage IA or IIAHD with favorable or masses entered a prospectiv e multicenter study started in January 1988. The median follow-vp time was 38 months. Results: All patients achieved a complete remission (C R). Five relapsed after 3 to 40 months and underwent successful salvag e therapy. The actuarial remission rate wets 0.89% at 3 years and 0.82 % at 5 years. Two patients died in CR: one of severe pulmonary toxicit y, the other of a second neoplasia (adenocarcinoma of the lung), 2 and 43 months after the end of therapy, respectively. The hematologic tox icity recorded during VBM CT was mild on the whole, Major toxicity was represented by pulmonary side effects and neurologic symptoms. Multip le regression analysis demonstrated that pulmonary toxicity was signif icantly related only to the amount of RT delivered to the mediastinum and not to the relative dose of bleomycin, to the dose-intensities of the three drugs in the regimen, or to patient age or sex, The same sta tistical technique showed that the only clinical factor related to gra de of neurotoxicity was vinblastine dosage. Conclusion: VBM CT combine d with EF RT is an effective treatment early, clinically staged, favor able HD patients, However, the toxicity of this combination suggests t hat certain modifications should be evaluated. (C) 1996 by American So ciety of Clinical Oncology.