Sequential chemotherapy (etoposide, vinblastine, and doxorubicin) and subtotal lymph node radiation for patients with localized Hodgkin disease and unfavorable prognostic features - A phase II Cancer and Leukemia Group B study (9051)

BACKGROUND. The aim of this study was to evaluate a regimen of sequential c hemotherapy and radiotherapy for patients with Hodgkin disease. METHODS. The Cancer and Leukemia Group B conducted a Phase II study of thre e cycles of etoposide, vinblastine, and doxorubicin (EVA) chemotherapy foll owed by subtotal lymph node radiation for patients with localized Hodgkin d isease and unfavorable prognostic features. Fifty-nine patients were enroll ed in the study. Fifty-three patients met all study eligibility criteria; 4 8 of them (91%) had medias tinal disease and 29 (55%) had bulky mediastinal disease. RESULTS. A complete response (CR) occurred in 35 of the patients (66%). Of all patients who had CR, 26% had the CR after the chemotherapy and before t he radiation, and 74% after the chemotherapy and radiation. Twenty percent of the patients who had CR experienced disease progression; in these patien ts, the progression was outside the radiotherapy field in the lung and invo lved widespread disease. CONCLUSIONS. EVA offers a nonbleomycin-containing alternative for patients in whom preexisting pulmonary disease may be exacerbated by bleomycin and r adiation therapy. EVA, as given in this study tin three cycles), was insuff icient chemotherapy for patients who had disease in areas outside the radia tion fields (occult disease). (C) 1999 American Cancer Society.