Originally published as JCO Early Release 10.1200/JCO.2004.01.021 on December 2 2003

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Consolidation Radiation After Complete Remission in Hodgkin's Disease Following Six Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine Chemotherapy: Is There a Need?

From the Departments of Radiation Oncology, Medical Oncology, and Pathology, Tata Memorial Hospital, Mumbai, India

Address reprint requests to Siddhartha Laskar, MD, Department of Radiation Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel 400 012, Mumbai, India; e-mail:laskars2000{at}yahoo.com

PURPOSE: Combined modality treatment using multidrug chemotherapy (CTh) and radiotherapy (RT) is currently considered the standard of care in early stage Hodgkin's disease. Its role in advanced stages, however, continues to be debated. This study was aimed at evaluating the role of consolidation radiation in patients achieving a complete remission after six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy using event-free survival (EFS) and overall survival (OS) as primary end points.

PATIENTS AND METHODS: Two hundred and fifty-one patients with Hodgkin's disease attending the lymphoma clinic at the Tata Memorial Hospital (Mumbai, India) from 1993 to 1996 received induction chemotherapy with six cycles of ABVD after initial staging evaluation. A total of 179 of 251 patients (71%) achieved a complete remission after six cycles of ABVD chemotherapy and constituted the randomized population. Patients were randomly assigned to receive either consolidation radiation or no further therapy.

RESULTS: With a median follow-up of 63 months, the 8-year EFS and OS in the CTh-alone arm were 76% and 89%, respectively, as compared with 88% and 100% in the CTh+RT arm (P = .01; P = .002). Addition of RT improved EFS and OS in patients with age < 15 years (P = .02; P = .04), B symptoms (P = .03; P = .006), advanced stage (P = .03; P = .006), and bulky disease (P = .04; P = .19).

CONCLUSION: Our study suggests that the addition of consolidation radiation helps improve the EFS and OS in patients achieving a complete remission after six cycles of ABVD chemotherapy, particularly in the younger age group and in patients with B symptoms and bulky and advanced disease.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

Related Editorial

• Chemotherapy or Combined Modality Treatment: The Optimal Treatment for Hodgkin's Disease
  Volker Diehl
  JCO 2004 22: 15-18 [Full Text]

Related Correspondence

• Radiotherapy in Advanced-Stage Hodgkin's Lymphoma
  John M.M. Raemaekers, Berthe M.P. Aleman, and Michel Henry-Amar
  JCO 2005 23: 245-246 [Full Text]

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