Chemotherapy Alone Compared with Chemotherapy plus Radiotherapy for Localized Intermediate- and High-Grade Non-Hodgkin's Lymphoma
Thomas P. Miller, M.D., Steve Dahlberg, M.S., J. Robert Cassady, M.D., David J. Adelstein, M.D., Catherine M. Spier, M.D., Thomas M. Grogan, M.D., Michael LeBlanc, Ph.D., Susan Carlin, B.A., Ellen Chase, B.S., and Richard I. Fisher, M.D.
Background Patients with clinically localized, intermediate-or high-grade non-Hodgkin's lymphoma usually receive initialtreatment with a doxorubicin-containing regimen such as cyclophosphamide,doxorubicin, vincristine, and prednisone (CHOP). Pilot studiessuggest that eight cycles of CHOP alone or three cycles of CHOPfollowed by involved-field radiotherapy are effective in suchpatients.
Methods We compared these two approaches in a prospective, randomized,multi-institutional study. The end points were progression-freesurvival, overall survival, and life-threatening or fatal toxiceffects. Two hundred eligible patients were randomly assignedto receive CHOP plus radiotherapy, and 201 received CHOP alone.
Results Patients treated with three cycles of CHOP plus radiotherapyhad significantly better progression-free survival (P=0.03)and overall survival (P=0.02) than patients treated with CHOPalone. The five-year estimates of progression-free survivalfor patients receiving CHOP plus radiotherapy and for patientsreceiving CHOP alone were 77 percent and 64 percent, respectively.The five-year estimates of overall survival for patients receivingCHOP plus radiotherapy and for patients receiving CHOP alonewere 82 percent and 72 percent, respectively. The adverse effectsincluded one death in each treatment group. Life-threateningtoxic effects of any type were seen in 61 of 200 patients treatedwith CHOP plus radiotherapy and in 80 of 201 patients treatedwith CHOP alone (P=0.06). The left ventricular function wasdecreased in seven patients who received CHOP alone, whereasno cardiac events were recorded in the group receiving CHOPplus radiotherapy (P=0.02).
Conclusions Three cycles of CHOP followed by involved-fieldradiotherapy are superior to eight cycles of CHOP alone forthe treatment of localized intermediate- and high-grade non-Hodgkin'slymphoma.
Source Information
From the Arizona Cancer Center, University of Arizona, Tucson (T.P.M., J.R.C., C.M.S., T.M.G., E.C.); the Southwest Oncology Group Statistical Center, Seattle (S.D., M.L., S.C.); the Cleveland Clinic Foundation, Cleveland (D.J.A.); and the Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, Ill. (R.I.F.).
Address reprint requests to Dr. Miller at the Southwest Oncology Group, Operations Office, 14980 Omicron Dr., San Antonio, TX 78245-3217.
Treatment of Intermediate-Grade and High-Grade Non-Hodgkin's Lymphoma
Wirth A., Prince H. M., Wolf M., Machida U., Kami M., Hirai H., Mounier N., Gisselbrecht C., Lepage E., Kosmas C., Malamos N. A., Antonopoulos M. J., Decaudin D., Miller T. P., LeBlanc M., Fisher R. I., The Southwest Oncology Group
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N Engl J Med 1998;
339:1475-1477, Nov 12, 1998.
Correspondence
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