Journal of Clinical Oncology, Vol 9, 1983-1993, Copyright © 1991 by American Society of Clinical Oncology
Combined modality therapy of Hodgkin's disease: 10-year results of National Cancer Institute of Canada Clinical Trials Group multicenter clinical trial
L Yelle, D Bergsagel, V Basco, T Brown, R Bush, J Gillies, L Israels, A Miller, D Rideout and D Whitelaw
National Cancer Institute of Canada Clinical Trials Group, Kingston.
The purpose of this study was to compare four methods of treatment for
stage III-IV Hodgkin's disease. Between January 1972 and September 1976,
266 patients with stage IIIB, IVA, and IVB Hodgkin's disease from 21 cancer
treatment centers across Canada were registered as eligible; 40 were found
to be ineligible. Of the 226 remaining patients, only seven were followed
for less than 10 years. All patients received three courses of
mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)
chemotherapy, which induced a complete response (CR) in 36%; an additional
42% obtained adequate disease control. Patients were randomly assigned to
(1) treatment with radiation to the abdomen and mantle (group AX3, 62
patients) or (2) continue their treatment with an additional three courses
of MOPP (group A, 105 patients). For the A group, a second randomization
took place 3 months later (regardless of status at that time) to (1) no
further treatment (AC6, 23 patients), (2) radiotherapy to the abdomen and
mantle (AX6, 48 patients), or (3) maintenance chemotherapy at 3-month
intervals for 1 year (AC10, 26 patients). The survival of AX3 patients was
somewhat better than for the A group, but the difference was not
significant (P = .0565). However, there was a significant interaction (P =
.0029) between age and treatment, so that among patients less than 30 years
of age, the survival of the A group was better, whereas for older patients,
treatment with AX3 resulted in improved survival. Age itself remained a
significant prognostic factor for survival after controlling for the amount
of radiotherapy delivered to the abdomen and the dose intensity of
vincristine for the first three courses of chemotherapy. The addition of
radiation therapy to MOPP significantly reduced the frequency of nodal
relapses. These results suggest that combined modality therapy may be
beneficial for some patients with Hodgkin's disease and that age must be
carefully considered in interpreting the results of clinical trials in
Hodgkin's disease.
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