Originally published as JCO Early Release 10.1200/JCO.2005.09.085 on April 18 2005

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Randomized Comparison of ABVD Chemotherapy With a Strategy That Includes Radiation Therapy in Patients With Limited-Stage Hodgkin’s Lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group

From the Juravinski Cancer Centre and McMaster University, Hamilton; Ottawa Hospital and University of Ottawa, Ottawa; London Health Sciences and University of Western Ontario, London; National Cancer Institute of Canada Clinical Trials Group, Queens University, Kingston; Princess Margaret Hospital and University of Toronto, Toronto, Ontario; British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia; Cross Cancer Institute and University of Alberta, Edmonton, Alberta; Feinberg School of Medicine, Northwestern University, Chicago, IL; and Stanford University, Palo Alto, CA

Address reprint requests to Ralph M. Meyer, MD, Division of Hematology, Juravinski Cancer Centre, Hamilton, Ontario, L8V 5C2, Canada; e-mail: ralph.meyer{at}hrcc.on.ca

PURPOSE: We report results of a randomized trial comparing ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy alone with treatment that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma.

PATIENTS AND METHODS: Patients with nonbulky clinical stage I to IIA Hodgkin's lymphoma were stratified into favorable and unfavorable risk cohorts. Patients allocated to radiation-containing therapy received subtotal nodal radiation if favorable risk or combined-modality therapy if unfavorable risk. Patients allocated to ABVD received four to six treatment cycles.

RESULTS: We evaluated 399 patients. Median follow-up is 4.2 years. In comparison with ABVD alone, 5-year freedom from disease progression is superior in patients allocated to radiation therapy (P = .006; 93% v 87%); no differences in event-free survival (P = .06; 88% v 86%) or overall survival (P = .4; 94% v 96%) were detected. In a subset analyses comparing patients stratified into the unfavorable cohort, freedom from disease progression was superior in patients allocated to combined-modality treatment (P = .004; 95% v 88%); no difference in overall survival was detected (P = .3; 92% v 95%). Of 15 deaths observed, nine were attributed to causes other than Hodgkin's lymphoma or acute treatment-related toxicity.

CONCLUSION: In patients with limited-stage Hodgkin's lymphoma, no difference in overall survival was detected between patients randomly assigned to receive treatment that includes radiation therapy or ABVD alone. Although 5-year freedom from disease progression was superior in patients receiving radiation therapy, this advantage is offset by deaths due to causes other than progressive Hodgkin's lymphoma or acute treatment-related toxicity.

Presented at the 45th Annual Meeting of the American Society of Hematology, San Diego, CA, December 6-9, 2003.

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

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