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ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results.
J Clin Oncol 2004; 22(14):2835-41JC

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.

Authors+Show Affiliations

Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy. gianni.bonadonna@istitutotumori.mi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15199092

Citation

Bonadonna, Gianni, et al. "ABVD Plus Subtotal Nodal Versus Involved-field Radiotherapy in Early-stage Hodgkin's Disease: Long-term Results." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 22, no. 14, 2004, pp. 2835-41.
Bonadonna G, Bonfante V, Viviani S, et al. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. J Clin Oncol. 2004;22(14):2835-41.
Bonadonna, G., Bonfante, V., Viviani, S., Di Russo, A., Villani, F., & Valagussa, P. (2004). ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 22(14), pp. 2835-41.
Bonadonna G, et al. ABVD Plus Subtotal Nodal Versus Involved-field Radiotherapy in Early-stage Hodgkin's Disease: Long-term Results. J Clin Oncol. 2004 Jul 15;22(14):2835-41. PubMed PMID: 15199092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. AU - Bonadonna,Gianni, AU - Bonfante,Valeria, AU - Viviani,Simonetta, AU - Di Russo,Anna, AU - Villani,Fabrizio, AU - Valagussa,Pinuccia, Y1 - 2004/06/15/ PY - 2004/6/17/pubmed PY - 2004/9/4/medline PY - 2004/6/17/entrez SP - 2835 EP - 41 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 22 IS - 14 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. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/15199092/ABVD_plus_subtotal_nodal_versus_involved_field_radiotherapy_in_early_stage_Hodgkin's_disease:_long_term_results_ L2 - http://ascopubs.org/doi/full/10.1200/JCO.2004.12.170?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -