Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease

New England Journal of Medicine (Impact Factor: 54.42). 03/2008; 358(7):742; author reply 743. DOI: 10.1056/NEJMc073375
Source: PubMed
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    ABSTRACT: Since 1964, the EORTC Lymphoma Group has conducted nine consecutive randomized phase III trials on early-stage Hodgkin lymphoma aimed at increasing efficacy while decreasing short- and long-term toxicities. Event-free and overall survival significantly improved from about 50% and 70%, respectively, in the early years to over 80% and 90%, respectively, more recently. Identification of prognostic subgroups appeared to be a successful method to tailor treatment strategies. Radiotherapy fields have become more restricted whereas chemotherapy has become standard. Early PET-CT has been introduced to investigate the possibility of treatment adaptation. Longitudinal quality-of-life assessment has become an integral part of our studies. An ongoing study focuses on the rehabilitation and quality of long-term survival in all 6658 Hodgkin lymphoma patients treated in EORTC trials since the earliest beginning. In advanced stages overall outcome has improved as well with 10-year survival rates of over 75%.
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    ABSTRACT: The development of curative chemotherapy regimens for the treatment of Hodgkin's lymphoma (HL) is one of the true success stories in oncology. Most patients diagnosed with HL today can be cured. The major task remaining before us is curing as many patients as possible with their initial therapeutic approach while minimizing the acute toxicities and limiting the lifetime risks of important secondary events such as cardiovascular complications and secondary malignancies. In the 40 years since DeVita et al. developed the mechlorethamine, vincristine, procarbazine, and prednisone chemotherapy regimen, we have learned a great deal about risk stratification to minimize treatment-related toxicity. Positron emission tomography may further assist us in reducing radiation treatment without compromising cures. This review will discuss the development of the chemotherapy regimens used in the management of early and advanced stage HL and the advantages and disadvantages of their use in combination with radiation therapy.
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