Treatment of early stage Hodgkin’s disease: A randomized trial of radiotherapy plus chemotherapy versus chemotherapy alone

Abstract

In 1976, extended field megavoltage radiation had become standard therapy for Hodgkin’s disease confined to lymph nodes [1, 2]. While essentially all patients with Stage I disease are cured by this technique, it has become apparent that a significant number of patients with more advanced disease relapse after treatment with radiotherapy alone. This is especially true of Stage IIIA disease [3], and those with large mediastinal masses with or without extranodal extension into lung [4, 5], but among all Stages I and II, relapse rates as high as 27% have been reported [6]. The recognition that combination chemotherapy could prolong both duration of second remission and survival in patients relapsing after radiation therapy [6, 7], prompted the evaluation of several combined modality regimens as initial treatment in patients with Stages I to IIIA disease [8–12]. The apparent benefits of this approach in terms of remission duration [9], and the growing awareness of undesirable long-term toxic effects of combined modality therapy [13], prompted the present study. Interim analyses have been presented previously [14, 15].