In early-stage Hodgkin’s lymphoma (HL), subtotal nodal irradiation (STNI) and combined chemotherapy/radiotherapy produce high disease control rates and significant late toxicity. The goal of this study was to reduce toxicity while maintaining disease control by combining low-intensity chemotherapy and involved-field radiotherapy (IF-RT).
Patients and methods: Patients with stage I or II HL were divided into groups based on four prognostic factors: age, symptoms, number of involved areas, and mediastinal-thoracic ratio. Six cycles of epirubicin, bleomycin, vinblastine, and prednisone (EBVP) were administered, followed by IF-RT. It was randomly compared to STNI in favorable patients and six cycles of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV hybrid), and IF-RT in unfavorable patients.
The median follow-up time for the 722 patients included in the study was nine years. The 10-year event-free survival (EFS) rates in 333 favorable patients were 88% in the EBVP arm and 78% in the STNI arm (P =.0113), with similar 10-year overall survival (OS) rates (92% v 92%, respectively; P =.79). In 389 unfavorable patients, the MOPP/ABV arm had a 10-year EFS rate of 88% compared to 68% in the EBVP arm (P =.001), resulting in 10-year OS rates of 87% and 79%, respectively (P =.0175).
Conclusion: A prognostic factor-based treatment strategy for early-stage HL results in high OS rates in both favorable and unfavorable patients. The combination of EBVP and IF-RT can be used in suitable patients instead of STNI as the standard treatment. EBVP is significantly less effective than MOPP/ABV in unfavorable patients.
Include an overview of the modality, its theory, and practice technique, and a section on research evaluating its effectiveness with at least one major disorder.