Journal of Clinical Oncology, Vol 15, 1736-1744, Copyright © 1997 by American Society of Clinical Oncology
Stanford-Kaiser Permanente G1 study for clinical stage I to IIA Hodgkin's disease: subtotal lymphoid irradiation versus vinblastine, methotrexate, and bleomycin chemotherapy and regional irradiation
SJ Horning, RT Hoppe, J Mason, BW Brown, SL Hancock, D Baer and SA Rosenberg
Department of Medicine, Stanford University Medical Center, CA, USA. sjh@mariposa.stanford.edu
PURPOSE: We have demonstrated that a relatively mild chemotherapy regimen,
vinblastine, methotrexate, and bleomycin (VBM), and involved- field
radiotherapy (IFRT) could substitute for extended-field radiotherapy in
patients with favorable Hodgkin's disease (HD) who have been
laparotomy-staged. The purpose of this study is to determine if VBM and
regional radiotherapy can substitute for extended-field radiotherapy in
favorable clinical stage (CS) I and II HD. PATIENTS AND METHODS:
Seventy-eight patients with favorable CS I to II HD were randomly assigned
to subtotal lymphoid irradiation (STLI) or VBM chemotherapy and regional
radiotherapy. Randomization was stratified on the basis of age, sex, number
of Ann Arbor sites, histology, and institution. Patients were evaluated for
freedom from progressive HD, survival, and toxicity. Results were compared
with the predecessor trial in pathologically staged patients. RESULTS: With
a median follow- up period of 4 years, the rate of freedom from progressive
HD was 92% (95% confidence interval [CI], 88% to 96%) for patients treated
with STLI and 87% (95% CI, 81% to 93%) for patients treated with VBM and
regional radiotherapy. Six of seven patients who relapsed are alive and in
remission following successful second-line therapy. CONCLUSION: Given the
caveat of a small number of patients, the results of extended- field
radiotherapy and VBM and regional radiotherapy are comparable with a median
follow-up period of 4 years. VBM serves as a paradigm to reduce late
effects in favorable early-stage HD. We do not advocate its routine use in
clinical practice, but instead encourage participation in clinical trials
with the objective of maintaining efficacy while reducing toxicity in CS I
and II HD.
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