ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: Long-term results

Gianni Bonadonna, Valeria Bonfante, Simonetta Viviani, Anna Di Russo, Fabrizio Villani, Pinuccia Valagussa

Research output: Contribution to journalArticle

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Abstract

Purpose: Radiation therapy (RT) alone can cure more than 80% of all patients with pathologic stage IA, IB, and IIA Hodgkin's disease, but some prognostic factors unfavorably affect treatment outcome. Combined-modality approaches improved results compared with RT, but the optimal extent of RT fields when combined with chemotherapy warranted additional evaluation. Patients and Methods: In February 1990, we activated a prospective trial in patients with early, clinically staged Hodgkin's disease to assess efficacy and tolerability of four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by either subtotal nodal plus spleen irradiation (STNI) or involved-field radiotherapy (IFRT). Results: Main patient characteristics were fairly well balanced between the two arms. Complete remission was achieved in 100% and in 97% of patients, respectively. The 12-year freedom from progression rates were 93% (95% CI, 83% to 100%) after ABVD and STNI, and 94% (95% CI, 88% to 100%) after ABVD and IFRT, whereas the figures for overall survival were 96% (95% CI, 91 % to 100%) and 94% (95% CI, 89% to 100%), respectively. Apart from three patients who developed second malignancies in the STNI arm, treatment-related morbidities were mild. Conclusion: Present long-term findings suggest that, after four cycles of ABVD, IFRT can achieve a worthwhile outcome. The limited size of our patient sample, however, had no adequate statistical power to test for noninferiority of IFRT versus STNI. Despite this, ABVD followed by IFRT can be considered an effective and safe modality in early Hodgkin's disease with both favorable and unfavorable presentation.

Original languageEnglish
Pages (from-to)2835-2841
Number of pages7
JournalJournal of Clinical Oncology
Volume22
Issue number14
DOIs
Publication statusPublished - 2004

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Hodgkin Disease
Radiotherapy
Spleen
Dacarbazine
Second Primary Neoplasms
Vinblastine
Bleomycin
Doxorubicin
Morbidity
Drug Therapy
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease : Long-term results. / Bonadonna, Gianni; Bonfante, Valeria; Viviani, Simonetta; Di Russo, Anna; Villani, Fabrizio; Valagussa, Pinuccia.

In: Journal of Clinical Oncology, Vol. 22, No. 14, 2004, p. 2835-2841.

Research output: Contribution to journalArticle

Bonadonna, Gianni ; Bonfante, Valeria ; Viviani, Simonetta ; Di Russo, Anna ; Villani, Fabrizio ; Valagussa, Pinuccia. / ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease : Long-term results. In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 14. pp. 2835-2841.
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abstract = "Purpose: Radiation therapy (RT) alone can cure more than 80{\%} of all patients with pathologic stage IA, IB, and IIA Hodgkin's disease, but some prognostic factors unfavorably affect treatment outcome. Combined-modality approaches improved results compared with RT, but the optimal extent of RT fields when combined with chemotherapy warranted additional evaluation. Patients and Methods: In February 1990, we activated a prospective trial in patients with early, clinically staged Hodgkin's disease to assess efficacy and tolerability of four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by either subtotal nodal plus spleen irradiation (STNI) or involved-field radiotherapy (IFRT). Results: Main patient characteristics were fairly well balanced between the two arms. Complete remission was achieved in 100{\%} and in 97{\%} of patients, respectively. The 12-year freedom from progression rates were 93{\%} (95{\%} CI, 83{\%} to 100{\%}) after ABVD and STNI, and 94{\%} (95{\%} CI, 88{\%} to 100{\%}) after ABVD and IFRT, whereas the figures for overall survival were 96{\%} (95{\%} CI, 91 {\%} to 100{\%}) and 94{\%} (95{\%} CI, 89{\%} to 100{\%}), respectively. Apart from three patients who developed second malignancies in the STNI arm, treatment-related morbidities were mild. Conclusion: Present long-term findings suggest that, after four cycles of ABVD, IFRT can achieve a worthwhile outcome. The limited size of our patient sample, however, had no adequate statistical power to test for noninferiority of IFRT versus STNI. Despite this, ABVD followed by IFRT can be considered an effective and safe modality in early Hodgkin's disease with both favorable and unfavorable presentation.",
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N2 - Purpose: Radiation therapy (RT) alone can cure more than 80% of all patients with pathologic stage IA, IB, and IIA Hodgkin's disease, but some prognostic factors unfavorably affect treatment outcome. Combined-modality approaches improved results compared with RT, but the optimal extent of RT fields when combined with chemotherapy warranted additional evaluation. Patients and Methods: In February 1990, we activated a prospective trial in patients with early, clinically staged Hodgkin's disease to assess efficacy and tolerability of four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by either subtotal nodal plus spleen irradiation (STNI) or involved-field radiotherapy (IFRT). Results: Main patient characteristics were fairly well balanced between the two arms. Complete remission was achieved in 100% and in 97% of patients, respectively. The 12-year freedom from progression rates were 93% (95% CI, 83% to 100%) after ABVD and STNI, and 94% (95% CI, 88% to 100%) after ABVD and IFRT, whereas the figures for overall survival were 96% (95% CI, 91 % to 100%) and 94% (95% CI, 89% to 100%), respectively. Apart from three patients who developed second malignancies in the STNI arm, treatment-related morbidities were mild. Conclusion: Present long-term findings suggest that, after four cycles of ABVD, IFRT can achieve a worthwhile outcome. The limited size of our patient sample, however, had no adequate statistical power to test for noninferiority of IFRT versus STNI. Despite this, ABVD followed by IFRT can be considered an effective and safe modality in early Hodgkin's disease with both favorable and unfavorable presentation.

AB - Purpose: Radiation therapy (RT) alone can cure more than 80% of all patients with pathologic stage IA, IB, and IIA Hodgkin's disease, but some prognostic factors unfavorably affect treatment outcome. Combined-modality approaches improved results compared with RT, but the optimal extent of RT fields when combined with chemotherapy warranted additional evaluation. Patients and Methods: In February 1990, we activated a prospective trial in patients with early, clinically staged Hodgkin's disease to assess efficacy and tolerability of four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by either subtotal nodal plus spleen irradiation (STNI) or involved-field radiotherapy (IFRT). Results: Main patient characteristics were fairly well balanced between the two arms. Complete remission was achieved in 100% and in 97% of patients, respectively. The 12-year freedom from progression rates were 93% (95% CI, 83% to 100%) after ABVD and STNI, and 94% (95% CI, 88% to 100%) after ABVD and IFRT, whereas the figures for overall survival were 96% (95% CI, 91 % to 100%) and 94% (95% CI, 89% to 100%), respectively. Apart from three patients who developed second malignancies in the STNI arm, treatment-related morbidities were mild. Conclusion: Present long-term findings suggest that, after four cycles of ABVD, IFRT can achieve a worthwhile outcome. The limited size of our patient sample, however, had no adequate statistical power to test for noninferiority of IFRT versus STNI. Despite this, ABVD followed by IFRT can be considered an effective and safe modality in early Hodgkin's disease with both favorable and unfavorable presentation.

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