Radiotherapy or chemotherapy as the initial treatment for stage IIIA Hodgkin's disease (Report no 13)

Abstract

This report describes three comparative studies of treatment methods in patients with Stage IIIA Hodgkin's disease in whom the extent of disease had been confirmed by a diagnostic laparotomy. The first trial (1970-75) compared TNI with MOPP. The recurrence-free survival curve for patients treated with TNI was significantly better than that for those treated with MOPP at four years, but the survival rate of the two cohorts was identical, presumably because of good salvage treatment. The second study (1975-80) compared TNI with TNI followed by LOPP. Initially the addition of LOPP appeared to improve the disease-free survival rate but at three years no difference was apparent between the two treatment groups. The third (1980-present) study divides patients into those with and those without splenic involvement. Retrospective analysis of all patients included in the BNLI with Stage IIIA Hodgkin's disease confirmed by laparotomy and treated initially by TNI shows that splenic involvement does not influence the survival but decreases the relapse-free survival rate, making additional treatment with MOPP necessary in 75% of long-term survivors. In the current study, patients without splenic involvement are treated with TNI whereas those with splenic involvement are treated initially with chemotherapy, randomising between MOPP and LOPP.