Phase III randomized intergroup trial of subtotal lymphoid irradiation versus doxorubicin, vinblastine, and subtotal lymphoid irradiation for stage IA to IIA Hodgkin's disease

O. W. Press, M. LeBlanc, A. S. Lichter, T. M. Grogan, J. M. Unger, T. H. Wasserman, E. R. Gaynor, B. A. Peterson, Thomas P Miller, R. I. Fisher

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Purpose: The management of early-stage Hodgkin's disease in the United States is controversial. To evaluate whether staging laparotomy could be safely avoided in early-stage Hodgkin's disease and whether chemotherapy should be a part of the treatment of nonlaparotomy staged patients, a phase III intergroup trial was performed. Patients and Methods: Three hundred forty-eight patients with clinical stage IA to IIA supradiaphragmatic Hodgkin's disease were randomized without staging laparotomy to treatment with either subtotal lymphoid irradiation (STLI) or combined-modality therapy (CMT) consisting of three cycles of doxorubicin and vinblastine followed by STLI. Results: The study was closed at the second, planned, interim analysis because of a markedly superior failure-free survival (FFS) rate for patients on the CMT arm (94%) compared with the STLI arm (81%). With a median follow-up of 3.3 years, 10 patients have experienced relapse or died on the chemoradiotherapy arm, compared with 34 on the radiotherapy arm (P < .001). Few deaths have occurred on either arm (three deaths on CMT and seven deaths on STLI). Treatment was well tolerated, with only one death on each arm attributed to treatment. Conclusion: These results demonstrate that it is possible to obtain a high FFS rate in a large group of stage IA to IIA patients without performing staging laparotomy and that three cycles of chemotherapy plus STLI provide a superior FFS compared with STLI alone. Extended follow-up is necessary to assess freedom from second relapse, overall survival, late toxicities, patterns of treatment failure, and quality of life.

Original languageEnglish (US)
Pages (from-to)4238-4244
Number of pages7
JournalJournal of Clinical Oncology
Volume19
Issue number22
StatePublished - Nov 15 2001
Externally publishedYes

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Lymphatic Irradiation
Vinblastine
Hodgkin Disease
Doxorubicin
Combined Modality Therapy
Laparotomy
Survival Rate
Recurrence
Drug Therapy
Survival
Chemoradiotherapy
Therapeutics
Treatment Failure
Radiotherapy
Quality of Life

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Press, O. W., LeBlanc, M., Lichter, A. S., Grogan, T. M., Unger, J. M., Wasserman, T. H., ... Fisher, R. I. (2001). Phase III randomized intergroup trial of subtotal lymphoid irradiation versus doxorubicin, vinblastine, and subtotal lymphoid irradiation for stage IA to IIA Hodgkin's disease. Journal of Clinical Oncology, 19(22), 4238-4244.

Phase III randomized intergroup trial of subtotal lymphoid irradiation versus doxorubicin, vinblastine, and subtotal lymphoid irradiation for stage IA to IIA Hodgkin's disease. / Press, O. W.; LeBlanc, M.; Lichter, A. S.; Grogan, T. M.; Unger, J. M.; Wasserman, T. H.; Gaynor, E. R.; Peterson, B. A.; Miller, Thomas P; Fisher, R. I.

In: Journal of Clinical Oncology, Vol. 19, No. 22, 15.11.2001, p. 4238-4244.

Research output: Contribution to journalArticle

Press, OW, LeBlanc, M, Lichter, AS, Grogan, TM, Unger, JM, Wasserman, TH, Gaynor, ER, Peterson, BA, Miller, TP & Fisher, RI 2001, 'Phase III randomized intergroup trial of subtotal lymphoid irradiation versus doxorubicin, vinblastine, and subtotal lymphoid irradiation for stage IA to IIA Hodgkin's disease', Journal of Clinical Oncology, vol. 19, no. 22, pp. 4238-4244.
Press, O. W. ; LeBlanc, M. ; Lichter, A. S. ; Grogan, T. M. ; Unger, J. M. ; Wasserman, T. H. ; Gaynor, E. R. ; Peterson, B. A. ; Miller, Thomas P ; Fisher, R. I. / Phase III randomized intergroup trial of subtotal lymphoid irradiation versus doxorubicin, vinblastine, and subtotal lymphoid irradiation for stage IA to IIA Hodgkin's disease. In: Journal of Clinical Oncology. 2001 ; Vol. 19, No. 22. pp. 4238-4244.
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AU - Press, O. W.

AU - LeBlanc, M.

AU - Lichter, A. S.

AU - Grogan, T. M.

AU - Unger, J. M.

AU - Wasserman, T. H.

AU - Gaynor, E. R.

AU - Peterson, B. A.

AU - Miller, Thomas P

AU - Fisher, R. I.

PY - 2001/11/15

Y1 - 2001/11/15

N2 - Purpose: The management of early-stage Hodgkin's disease in the United States is controversial. To evaluate whether staging laparotomy could be safely avoided in early-stage Hodgkin's disease and whether chemotherapy should be a part of the treatment of nonlaparotomy staged patients, a phase III intergroup trial was performed. Patients and Methods: Three hundred forty-eight patients with clinical stage IA to IIA supradiaphragmatic Hodgkin's disease were randomized without staging laparotomy to treatment with either subtotal lymphoid irradiation (STLI) or combined-modality therapy (CMT) consisting of three cycles of doxorubicin and vinblastine followed by STLI. Results: The study was closed at the second, planned, interim analysis because of a markedly superior failure-free survival (FFS) rate for patients on the CMT arm (94%) compared with the STLI arm (81%). With a median follow-up of 3.3 years, 10 patients have experienced relapse or died on the chemoradiotherapy arm, compared with 34 on the radiotherapy arm (P < .001). Few deaths have occurred on either arm (three deaths on CMT and seven deaths on STLI). Treatment was well tolerated, with only one death on each arm attributed to treatment. Conclusion: These results demonstrate that it is possible to obtain a high FFS rate in a large group of stage IA to IIA patients without performing staging laparotomy and that three cycles of chemotherapy plus STLI provide a superior FFS compared with STLI alone. Extended follow-up is necessary to assess freedom from second relapse, overall survival, late toxicities, patterns of treatment failure, and quality of life.

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