BULKY MEDIASTINAL HODGKINS-DISEASE - RESULTS OF A COMBINED-MODALITY APPROACH (ABVD MOPP ALTERNATING CHEMOTHERAPY PLUS RADIATION-THERAPY)

Background. Bulky mediastinal involvement is a challenging presentatio n of Hodgkin's disease (HD). Radiotherapy alone has provided a good re sponse rate but also a high percentage of recurrences, and therefore m any studies have been initiated to evaluate combined modality treatmen t. Method. In a prospective study 23 stage IIA/IIIB HD patients treate d with ABVD/MOPP alternating chemotherapy and radiotherapy were evalua ted with regard to overall (OS) and disease-free survival (DFS), acute and long-term toxicity. Results. A 95% CR rate was obtained. Ten-year actuarial OS and DFS were 83 and 91%, respectively. Two patients (8.8 %) relapsed 8 and 9 months after achieving CR. One patient (4.4%) died following severe bone marrow failure 25 months after diagnosis. No cl inically evident acute or chronic cardiac or pulmonary toxicity was ev ident, and no second malignancies were observed. At the end of therapy 7/14 evaluable women became amenorrheal and remained so at their last follow-up. Two male patients were considered azoospermic on the basis of laboratory evaluation at the end of therapy, and after 68 and 122 months, respectively; 4 of 5 male patients had sexual intercourse free ly but did not fertilize their partners. Conclusions. In our opinion a nd in agreement with available literature, chemotherapy has a fundamen tal place alongside radiotherapy in the treatment of bulky mediastinal HD. Combined modality treatment improves the disease-free survival ob tained with radiotherapy or chemotherapy alone. In our experience a hi gh percentage of patients (83%) can be considered cured without the ne ed for second-line therapy. However, long-term and especially gonadal toxicity greatly influence the quality of life of these patients. Ther efore treatment must be personalized according to age, sex, cardiopulm onary status and desire to preserve reproductive function.