BRIEF CHEMOTHERAPY, STANFORD-V, AND ADJUVANT RADIOTHERAPY FOR BULKY OR ADVANCED-STAGE HODGKINS-DISEASE - A PRELIMINARY-REPORT

Purpose: Although survival rates have improved for patients with bulky and advanced-stage Hodgkin's disease (HD), current treatments entail substantial acute morbidity and risks for late effects such as inferti lity, second malignancies, and cardiopulmonary toxicities. A novel, br ief chemotherapy regimen (doxorubicin, vinblastine, mechlorethamine, v incristine, bleomycin, etoposide, and prednisone [Stanford V]) was des igned to shorten the duration of treatment, significantly reduce cumul ative doses of alkylating agents, doxorubicin, and bleomycin, and main tain dose-intensity (DI). This brief chemotherapy was combined with ra diation therapy (RT) to bulky disease sites. Methods: Since May 1989, 65 previously untreated patients were treated for stage II HD with bul ky mediastinal involvement (n = 21) or for stage III or IV HD (n = 44) . Patients received weekly chemotherapy for 12 weeks. Consolidative RT was given to the first 25 patients to sites of initial bulky disease or radiogaphic abnormalities that persisted after chemotherapy; in the remaining 40 patients, RT was limited to bulky disease (adenopathy gr eater than or equal to 5 cm and/or macroscopic splenic nodules defined by computed tomography [CT]). Results: With a median follow-up period of 2 years actuarial 3-year survival rate is 96% and failure-free sur vival (FFS) rate is 87%. The 3-year FFS rate is 100% for stage II pati ents with bulky mediastinal disease and 82% for patients with stage II I to IV disease. There were no treatment-related deaths. In a prelimin ary analysis on a subset of patients, female and male fertility appear s to be preserved. Conclusion: These preliminary results indicate that the Stanford V chemotherapy regimen with or without RT is well-tolera ted and effective therapy for bulky, limited-stage, and advanced-stage HD. Less cumulative exposure to alkylating agents, doxorubicin, and b leomycin and limited use of radiation is expected to decrease risks fo r second neoplasms and late cardiopulmonary toxicity. Based on these r esults, the Stanford V chemotherapy with or without RT regimen deserve s further study in the context of a randomized clinical trial.