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Previous Volume 348:2396-2406 June 12, 2003 Number 24 Next

Berthe M.P. Aleman, M.D., John M.M. Raemaekers, M.D., Ph.D., Umberto Tirelli, M.D., Ph.D., Roberto Bortolus, M.D., Ph.D., Mars B. van 't Veer, M.D., Ph.D., Marnix L.M. Lybeert, M.D., Jo J. Keuning, M.D., Ph.D., Patrice Carde, M.D., Ph.D., Théodore Girinsky, M.D., Ph.D., Richard W.M. van der Maazen, M.D., Ph.D., Radka Tomi, M.D., Marjeta Vovk, Marjeta Vovk, M.D., Ph.D., Achilles van Hoof, M.D., Ph.D., Geertrui Demeestere, M.D., Pieternella J. Lugtenburg, M.D., Ph.D., José Thomas, M.D., Ph.D., Wilfried Schroyens, M.D., Ph.D., Koenraad De Boeck, M.D., Johanna W. Baars, M.D., Ph.D., Johanna C. Kluin-Nelemans, M.D., Ph.D., Christian Carrie, M.D., Malek Aoudjhane, M.D., Dominique Bron, M.D., Ph.D., Houchingue Eghbali, M.D., Wilma G.J.M. Smit, M.D., Jacobus H. Meerwaldt, M.D., Ph.D., Anton Hagenbeek, M.D., Ph.D., Antonella Pinna, Michel Henry-Amar, M.D., Ph.D., for the European Organization for Research and Treatment of Cancer Lymphoma Group

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ABSTRACT

Background The use of involved-field radiotherapy after chemotherapy for advanced Hodgkin's lymphoma is controversial.

Methods We randomly assigned patients with previously untreated stage III or IV Hodgkin's lymphoma who were in complete remission after hybrid chemotherapy with mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP-ABV) to receive either no further treatment or involved-field radiotherapy. Radiotherapy consisted of 24 Gy to all initially involved nodal areas and 16 to 24 Gy to all initially involved extranodal sites. Patients in partial remission were treated with 30 Gy to nodal areas and 18 to 24 Gy to extranodal sites.

Results Of 739 patients, 421 had a complete remission; 161 of these patients were assigned to no further treatment, and 172 to involved-field radiotherapy. The median follow-up was 79 months. The five-year event-free survival rate was 84 percent in the group that did not receive radiotherapy and 79 percent in the group that received involved-field radiotherapy (P=0.35). The five-year overall survival rates were 91 and 85 percent, respectively (P=0.07). Among the 250 patients in partial remission after chemotherapy, the five-year event-free and overall survival rates were 79 and 87 percent, respectively.

Conclusions Involved-field radiotherapy did not improve the outcome in patients with advanced-stage Hodgkin's lymphoma who had a complete remission after MOPP-ABV chemotherapy. Radiotherapy may benefit patients with a partial response after chemotherapy.

Source Information

From the Netherlands Cancer Institute, Amsterdam (B.M.P.A., J.W.B.); the University Medical Center Nijmegen, Nijmegen, the Netherlands (J.M.M.R., R.W.M.M.); the National Cancer Institute, Aviano, Italy (U.T., R.B.); Erasmus University Medical Center, Rotterdam, the Netherlands (M.B.V., P.J.L., J.H.M., A.H.); Catharina Hospital, Eindhoven, the Netherlands (M.L.M.L.); Máxima Medisch Centrum, Veldhoven, the Netherlands (J.J.K.); Institut Gustave Roussy, Villejuif, France (P.C., T.G., A.P.); Institute of Oncology, Ljubljana, Slovenia (R.T., M.V.); Oncological Center Algemeen Ziekenhuis St. Jan, Brugge, Belgium (A.v.H., G.D.); University Hospital Gasthuisberg, Leuven, Belgium (J.T.); University Hospital Antwerp, Edegem, Belgium (W.S.); Algemeen Ziekenhuis Middelheim, Antwerp, Belgium (K.D.B.); Leiden University Medical Center, Leiden, the Netherlands (J.C.K.-N.); Centre Léon Bérard, Lyons, France (C.C.); Hôpital St. Antoine, Paris (M.A.); Institut Jules Bordet, Brussels, Belgium (D.B.); Institut Bergonié, Bordeaux, France (H.E.); Radiotherapeutisch Instituut Friesland, Leeuwarden, the Netherlands (W.G.J.M.S.); Medisch Spectrum Twente, Enschede, the Netherlands (J.H.M.); University Medical Center Utrecht, Utrecht, the Netherlands (A.H.); and Centre François Baclesse, Caen, France (M.H.-A.).

Drs. Aleman and Raemaekers contributed equally to the study.

Address reprint requests to Dr. Aleman at the Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands, or at b.aleman{at}nki.nl.

Full Text of this Article

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Extract | Full Text | PDF  
N Engl J Med 2003; 349:1187-1188, Sep 18, 2003. Correspondence

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