Combined-modality therapy for clinical stage I or II Hodgkin's lymphoma: Long-term results of the European organisation for research and treatment of cancer H7 randomized controlled trials

Evert M. Noordijk, Patrice Carde, Noëlle Dupouy, Anton Hagenbeek, Augustinus D G Krol, Johanna C. Kluin-Nelemans, Umberto Tirelli, Mathieu Monconduit, José Thomas, Houchingue Eghbali, Berthe M P Aleman, Jacques Bosq, Marjeta Vovk, Tom A M Verschueren, Anne Marie Pény, Théodore Girinsky, John M M Raemaekers, Michel Henry-Amar

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: In early-stage Hodgkin's lymphoma (HL), subtotal nodal irradiation (STNI) and combined chemotherapy/radiotherapy produce high disease control rates but also considerable late toxicity. The aim of this study was to reduce this toxicity using a combination of low-intensity chemotherapy and involved-field radiotherapy (IF-RT) without jeopardizing disease control. Patients and Methods: Patients with stage I or II HL were stratified into two groups, favorable and unfavorable, based on the following four prognostic factors: age, symptoms, number of involved areas, and mediastinal-thoracic ratio. The experimental therapy consisted of six cycles of epirubicin, bleomycin, vinblastine, and prednisone (EBVP) followed by IF-RT. It was randomly compared, in favorable patients, to STNI and, in unfavorable patients, to six cycles of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV hybrid) and IF-RT. Results: Median follow-up time of the 722 patients included was 9 years. In 333 favorable patients, the 10-year event-free survival rates (EFS) were 88% in the EBVP arm and 78% in the STNI arm (P = .0113), with similar 10-year overall survival (OS) rates (92% v 92%, respectively; P = .79). In 389 unfavorable patients, the 10-year EFS rate was 88% in the MOPP/ABV arm compared with 68% in the EBVP arm (P <.001), leading to 10-year OS rates of 87% and 79%, respectively (P = .0175). Conclusion: A treatment strategy for early-stage HL based on prognostic factors leads to high OS rates in both favorable and unfavorable patients. In favorable patients, the combination of EBVP and IF-RT can replace STNI as standard treatment. In unfavorable patients, EBVP is significantly less efficient than MOPP/ABV.

Original languageEnglish
Pages (from-to)3128-3135
Number of pages8
JournalJournal of Clinical Oncology
Volume24
Issue number19
DOIs
Publication statusPublished - Jul 1 2006

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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