HODGKINS-DISEASE WITH A MEDIASTINAL MASS GREATER-THAN 10 CM - RESULTSOF 4 DIFFERENT TREATMENT APPROACHES

Background. Management of Hodglkin's disease (HD) and large mediastina l adenopathy (LMA) usually includes intensive chemotherapy (CT) with o r without radiation therapy (XT) regardless of stage. Patients and met hods: One hundred and eighteen evaluable patients received one of four treatment regimens: (1) 6 cycles of MOPP or similar CT and XT; (2) 2 of MOPP followed by XT; (3) 6 of CVPP/ABDIC (cyclophosphamide, vincris tine, procarbazine, prednisone/doxorubicin, bleomycin, decarbazine, pr ednisone, lomustine) followed by XT; or (4) 3 of NOVP (mitoxantrone, v incristine, vinblastine, procarbazine) and XT. XT doses included 30-40 Gy to areas of nodal involvement noted prior to therapy. Results: Com plete remission (CR) rates for groups 1, 2, 3, and 4 were 100%, 85%, 8 7%, and 96%. Respective 3-year freedom from progression (FFP) results were 88%, 66%, 82%, and 88%, and 3-year freedom from tumor mortality ( FTM) results were 100%, 84%, 84%, and 100%. The presence of B symptoms and stage IV disease was correlated with lower CR and 3-year FFP rate s but similar 3-year survival. Conclusions: Results of this study sugg est that patients with stage I-III Hodgkin's disease and LMA greater t han 10 cm treated with 3 NOVP and XT have results similar to those obt ained for a similar group of patients treated with 2 to 6 MOPP or 6 CV PP/ABDIC and XT. NOVP has also been reported to produce limited toxici ty in this trial and should be considered as an alternative to MOPP or doxorubicin-containing regimens in treatment of patients with early-s taged disease and LMA greater than 10 cm.