A randomized trial of brief treatment of earlystage Hodgkin lymphoma: Is it effective?

BACKGROUND AND OBJECTIVESWhether it is possible to reduce the intensity of treatment in early (stage I or II) Hodgkin lymphoma with a favorable prognosis remains unclear. Therefore, we conducted this randomized trial, comparing two treatment groups consisting of a combination chemotherapy regimen of two different intensities followed by involved-field radiation therapy at two different dose levels.DESIGN AND SETTINGProspective, randomized, in patients referred to the Department of Clinical Oncology and Nuclear Medicine.PATIENTS AND METHODSNinety-eight patients with histologically proven early-stage Hodgkin lymphoma with a favorable prognosis were enrolled in this study between January 2008 and June 2010. They were randomly assigned in one of two treatment arms: arm I received four cycles of ABVD (Adriamycin, belomycin, vinblastine, dacarbazine) followed by 30 Gy of involved-field radiation therapy; arm II received two cycles of ABVD followed by 20 Gy of involved-field radiation therapy.RESULTSDuring the follow-up period, the 2-year relapse free survival rates were 96% and 95% in arm I and arm II, respectively(P= .8), while the 2-year overall survival rates were 98% and 95% in arm I and arm II, respectively (P= .16). Acute toxicity affected 54% of patients treated with four cycles of ABVD, who had grade III or IV toxicity, as compared with 30% of those receiving two cycles (P< .02). The rates of acute toxicity (grade III or IV) were also higher among patients treated with 30 Gy of involved-field radiation therapy than among those receiving 20 Gy (16% vs. 2.5%, P< .03).CONCLUSIONIn patients with early-stage Hodgkin lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy was as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy.