Risk adapted combined radio- and chemotherapy in Hodgkin's disease - 10-year follow-up

Background: In an open follow-up study we tested a treatment schedule of re duced combined radio- and chemotherapy in Hodgkin's disease in limited stag es with elevated risk factors (mediastina bulky disease, systemic B symptom s, extranodal lesions and unfavorable histological subtypes) and in advance d stages. The aim of the study was to reduce the delayed complications of f ull-dose combined modality treatment while preserving its effectiveness. Ma terial and Methods: From May 1985 to December 1988, 43 previously untreated patients entered the study. Treatment consisted of CVPP/ABVB (cyclophospha mide, vinblastine, procarbazine, prednisolone/doxorubicin, bleomycin, vincr istine, bendamustine) hybrid chemotherapy and involved-field, low-dose (25 Gy) radiation. Results:All patients could be evaluated for response to trea tment and follow-up. Primary complete remission was reached in 35/43 (81%) patients, partial remission in 5/43 (12%), and 3/43 (7%) failed to respond. After a median observation period of 124 (108-143) months, 27/35 complete responders are still in first complete remission. The survival data are as follows: relapse-free survival at 5 years is 81.5%, at 10 years 70%; overal l survival after 5 and 10 years 83% and 73%, respectively. So far, 8 patien ts relapsed and 8 patients died. The acute toxicity of the treatment progra m was moderate; concerning late toxicity we observed 2 secondary neoplasias (1 acute nonlymphocytic leukemia and 1 gastric carcinoma) in relapsed and heavily treated patients but none in the group of patients treated accordin g to the protocol. Conclusions: Combined reduced dosage radio- and chemothe rapy is effective in poor-risk Hodgkin's disease and seems not to increase the risk of secondary malignancies.