Advanced Hodgkin disease with large mediastinal involvement can be treatedwith eight cycles of chemotherapy alone after a major response to six cycles of chemotherapy - A study of 82 patients from the groupes d'Etudes des Lymphomes de ''adulte H89 Trial

Background. The prognostic impact of large mediastinal involvement (mediast inum/thorax [M/T] ratio > 0.33) in advanced Hodgkin disease (HD) and the op timal treatment with chemotherapy or combined treatment remains controversi al. Methods. Among 533 assessable patients with Ann Arbor Stage IIIB/IV HD incl uded in the H89 trial, 82 had large mediastinal mass defined on chest X-ray . All patients received induction with six cycles of chemotherapy (mechlore thamine, vincristine, procarbazine, prednisone-doxorubicin, bleomycin, vinb lastine or doxorubicin, vinblastine, bleomycin, procarbazine, prednisone); then complete and good partial responders were randomized between two conso lidation treatments: 2 cycles of the same chemotherapy or (sub)total lymph node irradiation. Results. Among 82 patients with an MIT ratio greater than 0.33, 48 were ver y large (ratio > 0.45). A large mediastinal mass was associated with suprad iaphragmatic disease, younger age, histologic nodular sclerosis, and differ ent sex ratio compared with other H89 trial patients. Biologic parameters a nd prognostic factors were similar for both groups. Although the major resp onse rate to induction chemotherapy (after 6 cycles) was lower for patients with large mediastinal mass (78% vs. 86%), the 5-year overall survival rat e (80% vs. 79%) and event free survival rate (59% vs. 61%) were similar (P = 0.64 and 0.3, respectively). The outcome was the same for patients (74%) with a large mediastinal mass randomized to I of the 2 consolidation arms. Analysis of progression showed that 68% (21 of 31) of failures occurred ear ly during treatment and involved the mediastinum in 86% of the cases. Conclusions, For patients with large mediastinal mass and advanced HD who a chieved a major response of at least 75% after 6 cycles of chemotherapy, a consolidation radiation therapy can be replaced by 2 additional cycles of c hemotherapy. Cancer 2001;92:453-9. (C) 2001 American Cancer Society.