Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin's disease who achieve a complete response to chemotherapy Journal Article


Authors: Nachman, J. B.; Sposto, R.; Herzog, P.; Gilchrist, G. S.; Wolden, S. L.; Thomson, J.; Kadin, M. E.; Pattengale, P.; Davis, P. C.; Hutchinson, R. J.; White, K.
Article Title: Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin's disease who achieve a complete response to chemotherapy
Abstract: Purpose: Current standard therapy for children and adolescents with Hodgkin's disease includes combination chemotherapy and low-dose involved-field radiation (LD-IFRT). Because radiation may be associated with adverse late effects, the Children's Cancer Group (CCG) investigated whether radiation could be omitted in patients achieving a complete response to initial chemotherapy without jeopardizing the excellent outcome obtained with combined-modality therapy. Patients and Methods: Between January 1995 and December 1998, 829 eligible patients were enrolled onto CCG 5942. A total of 501 patients who achieved an initial complete response after risk-adapted combination chemotherapy were randomized to receive LD-IFRT or no further treatment. Event-free survival (EFS) and overall survival were assessed from the date of study entry or the date of randomization, as appropriate. Results: The projected 3-year EFS from study entry for the entire cohort was 87% +/- 1.2%. Among patients who achieved a complete response to initial chemotherapy, 92% +/- 1.9% of those randomized to receive LD-IFRT were alive and disease free 3 years after randomization, versus 87% +/- 2.2% for patients randomized to receive no further therapy (stratified log-rank test; P = .057). With an "as-treated" analysis, 3-year EFS after randomization for the radiation cohort was 93% +/- 1.7% versus 85% +/- 2.3% for patients receiving no further therapy (stratified log-rank test; P = .0024). Three-year survival estimates for patients treated with and without LD-IFRT were 98% +/- 1.1% for patients who received radiation and 99% +/- 0.5% for patients who did not receive radiation. Conclusion: LD-IFRT after an initial complete response to risk-adapted chemotherapy improved EFS. At this time, there is no survival advantage for LD-IFRT, but follow-up remains short. (C) 2002 by American Society of Clinical Oncology.
Keywords: risk; childhood; radiation-therapy; malignant neoplasms; pediatric-oncology; adolescents; abvd; mopp; cancer
Journal Title: Journal of Clinical Oncology
Volume: 20
Issue: 18
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2002-09-15
Start Page: 3765
End Page: 3771
Language: English
ACCESSION: WOS:000178215600004
DOI: 10.1200/jco.2002.12.007
PROVIDER: wos
PUBMED: 12228196
Notes: Article -- Source: Wos
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  1. Suzanne L Wolden
    419 Wolden