Relapse and late complications in early-stage Hodgkin's disease patients with mediastinal involvement treated with radiotherapy alone or plus one cycle of ABVD

Background and Objectives. Patients affected by Hodgkin's disease (HD) in p athologic stage IA-IIA have a strong possibility of remission and long-term survival when treated with radiotherapy to extended fields. However, 20-30 % of cases relapse in the five years following treatment and consequently n eed further therapy. This study examines the occurrence of relapse and othe r complications in patients with pathologic stage IIA Hodgkin's disease and mediastinal involvement treated in different ways: radiotherapy alone vs r adiotherapy plus one cycle of adriamycin, bleomycin, vinblastine and dacarb azine (ABVD). Design and Methods. Our series consisted of 73 HD patients with mediastinal involvement treated by the Department of Radiation Oncology and the Hemato logy Department of "La Sapienza" University of Rome from 1983 to 1989. The patients were randomized into two groups according to their initial treatme nt. The first group contained 37 patients treated, initially, with supradia phragmatic radiotherapy and paraaortic irradiation (STNI); the second group was made up of 36 patients treated, initially, with supradiaphragmatic rad iotherapy and para-aortic irradiation (STNI) combined with one course of ad riamycin, bleomycin, vinblastine and dacarbazine (ABVD). For 28 (38%) of th e patients, the follow-up period was longer than 10 years. The average foll ow-up period was 114 months (range 22-174 months). Overall survival and rel apse-free survival were assessed using the Kaplan and Meier method, while d ifferences were tested by the log-rank test. Results. We recorded twelve cases of relapse after initial treatment. The p eriod of time which elapsed between the end of treatment and the evidence o f relapse ranged from 6 to 51 months, with an average of 22 months. Ten rel apses occurred in the STNI group and two in the ABVD/STNI group. No statist ically significant differences emerged between the two groups in the overal l survival analysis but did in the relapse-free survival analysis (p<0.01). In the group treated with ABVD and STNI one patient developed acute non-ly mphocytic leukemia and another patient treated at the age of 44 developed p rimary breast cancer. X-ray-related asymptomatic pulmonary fibrosis was obs erved in 12 patients: 10 cases in the STNI and ABVD group and 2 cases in th e group treated with RT alone. The other sequelae of combined CT/RT treatme nt in our study were thyroid dysfunction (2 cases, hypothyroidism), whereas the sequela of RT treatment was cardiac disease (2 cases). Interpretation and Conclusions. We conclude that one cycle of ABVD and radi otherapy in early-stage HD patients with mediastinal involvement may reduce the risk of relapse. Morever, the combination of low-toxicity CT and RT, a dministered preferably to limited fields, in patients who have not undergon e laparotomy could be a valid alternative to current treatment for early-st age HD. However, additional data and a longer follow-up are mandatory in or der to evaluate late toxicity and the potential risk of treatment. (C)1999, Ferrata Storti Foundation.