Treatment of early-stage Hodgkin's disease with four cycles of ABVD followed by adjuvant radiotherapy: analysis of efficacy and long-term toxicity

Background and Objectives. The use of combined modality therapy in early-st age Hodgkin's disease can spare staging laparotomy and reduces the risk of relapse compared to radiation alone. This paper reports on the efficacy and long-term events of a combined modality approach consisting of a brief cou rse of chemotherapy followed by adjuvant radiotherapy, without laparotomy, in early-stage Hodgkin's disease. Design and Methods. This study included 78 patients with Hodgkin's disease (20 in stage I and 58 in stage ii); 60% had mediastinal enlargement (12% ha d bulky disease) and 5% had subdiaphragmatic disease, Their median age was 33 years (range: 15-64) and median follow-up 60 months. The treatment progr am consisted of four cycles of ABVD followed by adjuvant radiation to invol ved sites (43 patients) or involved and contiguous sites of disease (35 pat ients); radiation doses ranged from 30 to 36 Gy to uninvolved and involved sites, respectively; bulky disease received up to 44 Gy, Gonadal function i n women was assessed by hormonal tests and evaluation of menses; young men were given the opportunity to have their semen cryopreserved. Results. The treatment program was completed in a median of 6.2 months (ran ge: 5-10). The complete remission rate was 88% after 4 courses of ABVD and 98.7% after adjuvant RT, The 5-year relapse-free survival was 97% and overa ll survival 98%; three patients died, one of disease progression and two of small cell lung carcinoma, Long-term events included three cases of pulmon ary fibrosis with symptomatic interstitial disease, one case of dilated car diomyopathy with cardiac failure tall had received mediastinal radiation) a nd four cases of dysthyroidism, Fertility was preserved in young women, wit h three subsequent normal pregnancies, Second neoplasms included two small cell lung carcinomas and one breast carcinoma. Intepretation and Conclusions. In early-stage Hodgkin's disease, four cycle s of ABVD followed by adjuvant radiotherapy produced a 5-year overall survi val of 98%. Prolonged monitoring for therapy-related long- term complicatio ns is mandatory in these potentially curable patients. (C)2000 Ferrata Stor ti Foundation.