A systematic overview of chemotherapy effects in Hodgkin's disease

A systematic review of chemotherapy trials in several tumour types was perf ormed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures For the evaluation of the scientific literature are describ ed separately (Acta Oncol 2001: 40: 155-65). This synthesis of the literatu re on chemotherapy for Hodgkin`s disease (HD) is based on 113 scientific re ports including four meta-analyses, 44 randomised studies, 18 prospective s tudies and 40 retrospective studies. These studies involve 69 196 patients. The conclusions reached can be summarised into the Following points: Chemotherapy is of utmost importance for the cure of HD At early stages, extended field radiotherapy cures most patients. For the m ajority of patients with relapse after radiotherapy. chemotherapy is curati ve and the total proportion of cured early stage patients is 75-90%. Chemot herapy in addition to extended field radiotherapy reduces recurrences but d oes not improve long-term survival. In early stage HD with a large mediastinal mass and/or with systemic sympto ms. combined treatment with chemotherapy and radiotherapy is recommended. It is likely that chemotherapy will play a greater role in the future in th e treatment also of early stage patients in order to reduce late consequenc es from extended field radiotherapy. However, this conclusion remains to be better documented in the literature. At advanced stages. chemotherapy or a combination of chemotherapy and limit ed field radiotherapy are effective treatment options and. using the regime ns available 10-20 years ago, 40-50% of the patients are cured. Based upon more favourable short-term (three to eight years) results of more recently developed regimens. it can be expected that today a higher proportion of th e patients will become long-term survivors. Several chemotherapy regimens containing four to eight drugs are effective in HD. The best regimen considering both antitumour activity and acute and late side-effects is not known. The choice of regimen is probably best done after considering various pre-treatment factors such as the number of poor prognostic signs, concomitant diseases and individual preferences. The results of chemotherapy are more favourable in young than in elderly pa tients. The development of less toxic but still effective treatment program mes is therefore particularly important For the elderly. High dose chemotherapy with stem cell support is presently often used in pa tients who are chemotherapy induction failures, who relapse after a short i nitial remission or after a longer initial remission and treated initially with seven or eight drugs, or who have had multiple relapses. However, this use is based on data From uncontrolled or small controlled studies, not be ing fully convincing with respect to effect on survival. Persistent side-effects or treatment are common among long-term survivors, although most patients have an apparently normal life. The relative contrib utions of chemotherapy and radiotherapy to the persistent effects are not w ell documented.