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Previous Volume 357:1916-1927 November 8, 2007 Number 19 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Diehl, V. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Treatment of early-stage Hodgkin's disease is usually tailored in line with prognostic factors that allow for reductions in the amount of chemotherapy and extent of radiotherapy required for a possible cure.

Methods From 1993 to 1999, we identified 1538 patients (age, 15 to 70 years) who had untreated stage I or II supradiaphragmatic Hodgkin's disease with favorable prognostic features (the H8-F trial) or unfavorable features (the H8-U trial). In the H8-F trial, we compared three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) combined with doxorubicin, bleomycin, and vinblastine (ABV) plus involved-field radiotherapy with subtotal nodal radiotherapy alone (reference group). In the H8-U trial, we compared three regimens: six cycles of MOPP-ABV plus involved-field radiotherapy (reference group), four cycles of MOPP-ABV plus involved-field radiotherapy, and four cycles of MOPP-ABV plus subtotal nodal radiotherapy.

Results The median follow-up was 92 months. In the H8-F trial, the estimated 5-year event-free survival rate was significantly higher after three cycles of MOPP-ABV plus involved-field radiotherapy than after subtotal nodal radiotherapy alone (98% vs. 74%, P<0.001). The 10-year overall survival estimates were 97% and 92%, respectively (P=0.001). In the H8-U trial, the estimated 5-year event-free survival rates were similar in the three treatment groups: 84% after six cycles of MOPP-ABV plus involved-field radiotherapy, 88% after four cycles of MOPP-ABV plus involved-field radiotherapy, and 87% after four cycles of MOPP-ABV plus subtotal nodal radiotherapy. The 10-year overall survival estimates were 88%, 85%, and 84%, respectively.

Conclusions Chemotherapy plus involved-field radiotherapy should be the standard treatment for Hodgkin's disease with favorable prognostic features. In patients with unfavorable features, four courses of chemotherapy plus involved-field radiotherapy should be the standard treatment. (ClinicalTrials.gov number, NCT00379041 [ClinicalTrials.gov] .)

Source Information

The authors' affiliations are listed in the Appendix.

Address reprint requests to Dr. Fermé at the Department of Medicine, Institut de Cancérologie Gustave Roussy, 39 Rue Camille Desmoulins, F-94805 Villejuif CEDEX, France, or at christophe.ferme{at}igr.fr.

Full Text of this Article

Related Letters:

Chemotherapy plus Involved-Field Radiation in Early-Stage Hodgkin's Disease
Olweny C. L.M., Ziegler J. L., Papac R. J., Subbiah V., Fermé C., Eghbali H., Henry-Amar M.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:742-743, Feb 14, 2008. Correspondence

This article has been cited by other articles:

• Olweny, C. L.M., Ziegler, J. L., Papac, R. J., Subbiah, V., Ferme, C., Eghbali, H., Henry-Amar, M. (2008). Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease.. NEJM 358: 742-743 [Full Text]  
• Diehl, V. (2007). Hodgkin's Disease -- From Pathology Specimen to Cure. NEJM 357: 1968-1971 [Full Text]  
• (2007). Combined Modality Therapy for Early-Stage Hodgkin Lymphoma. JWatch Oncology and Hematology 2007: 1-1 [Full Text]