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
P. Brice et al., 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, CANCER, 92(3), 2001, pp. 453-459
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.