EARLY-STAGE HODGKINS-DISEASE - LONG-TERM RESULTS WITH RADIOTHERAPY ALONE OR COMBINED RADIOTHERAPY AND CHEMOTHERAPY

Background: Controversy still exists over the optimal management of ea rly-stage Hodgkin's disease (HD); presentation features may have a dif ferent prognostic impact according to initial therapy, and long-term t oxicity must be fully evaluated. Patients and methods: This study incl uded 164 patients with stage IA-IIA HD treated with radiotherapy (RT) alone or combined radio- and chemotherapy (CT) according to presenting features and their attendant prognostic significance. The RT group in cluded 88 patients with favorable prognostic features; the combined mo dality group included 76 patients with one or more unfavorable feature s. In the RT group, 85% of patients received extended-mantle or STNI; in the combined modality group, RT consisted of mantle( 49%), extended mantle- (37%), and involved-field irradiation (140%); CT consisted of 6 cycles of MOPP before 1984; 3 cycles of ABVD were substituted for M OPP thereafter. Results: Complete remission was obtained in 94% and 99 % of patients of the RT and combined modality groups, respectively. Th e 10-year actuarial relapse-free survival (RFS) in the RT group was 62 % and was influenced by stage (p = 0.04) and histology (p = 0.01); in the combined modality group, RFS was 88% and was influenced by the pre sence of bulky disease. Overall survival and tumor mortality between t he therapy groups were comparable. RT-related toxicity consisted of me diastinal fibrosis (8 cases), myelitis (3), hypothyroidism (2); other long-term events included 2 cases of acute leukemia in the combined MO PP and RT group. Altogether, 8 of 20 patients who died were in their f irst complete remission. Conclusions: In stage IA-IIA HD, the combined modality therapy reduced the risk of relapse compared to radiation al one; long-term toxicity of RT was not negligible and relapses could oc cur late.