Correspondence

Hodgkin's Disease

N Engl J Med 1993; 329:361-362July 29, 1993

Article

To the Editor:

In their review of drug therapy for Hodgkin's disease (Feb. 25 issue),1 DeVita and Hubbard cite two trials conducted to compare chemotherapy alone with radiotherapy alone as treatment for stage I or II Hodgkin's disease2,3. They stated that both trials demonstrated that “combination therapy was as effective as radiotherapy.” The overall survival in the study by Biti et al.,2 with a median follow-up of eight years, however, was significantly higher among patients treated with radiotherapy than among those treated with chemotherapy (93 percent vs. 56 percent, P<0.001). Furthermore, the survival among patients who relapsed after initial therapy, as calculated from the time of relapse, was significantly better among those initially treated with radiotherapy than among those treated with chemotherapy (85 percent vs. 15 percent, P = 0.02). These results do not seem to support the assertion that combination chemotherapy and radiotherapy are equally efficacious for early-stage Hodgkin's disease.

Edith A. Perez, M.D.
Seth A. Rosenthal, M.D.
University of California, Davis, Cancer Center, Sacramento, CA 95817

3 References

1. 1

   DeVita VT Jr, Hubbard SM. Hodgkin's disease. N Engl J Med 1993;328:560-565
   Full Text | Web of Science | Medline

2. 2

   Biti GP, Cimino G, Cartoni C, et al. Extended-field radiotherapy is superior to MOPP chemotherapy for the treatment of pathologic stage I-IIA Hodgkin's disease: eight-year update of an Italian prospective randomized study. J Clin Oncol 1992;10:378-382
   Web of Science | Medline

3. 3

   Longo DL, Glatstein E, Duffey PL, et al. Radiation therapy versus combination chemotherapy in the treatment of early-stage Hodgkin's disease: seven-year results of a prospective randomized trial. J Clin Oncol 1991;9:906-917
   Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Drs. Perez and Rosenthal correctly point out that the outcomes of the two randomized, controlled trials comparing chemotherapy with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) with radiotherapy for early-stage Hodgkin's disease were different. This is because patients with stage IIIA disease and large mediastinal masses were included in the National Cancer Institute (NCI) study1 and patients with peripheral stage I disease were excluded. When only the comparable patients are considered, there are no significant differences in the rates of complete response or in the numbers of relapses with the different treatments. The survival differences in the study by Biti et al.2 are entirely accounted for by the results for the 12 patients in each arm who relapsed.

Without getting into details such as the problems posed by treating patients at multiple institutions and by variations in dosing, we nevertheless see some puzzling differences in the two studies. In the study by Biti et al.,2 the results for the patients who relapsed after radiotherapy were somewhat better than usual (salvage rate, 85 percent, vs. 50 percent in the NCI study), whereas only 17 percent of the patients who relapsed after primary MOPP chemotherapy survived (as compared with 57 percent in the NCI study).

The Italian2 and NCI1 studies were both small, and the varying results of salvage therapy blur comparisons of the two approaches as primary treatment for early-stage disease. . . . In addition, experience with patients with early-stage disease who relapse after receiving chemotherapy as their primary treatment is limited. This is why we concluded that the data are currently insufficient to recommend that chemotherapy alone replace radiotherapy as primary treatment for patients with early-stage Hodgkin's disease.

Vincent T. DeVita, Jr., M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 10021

Susan Molloy Hubbard, R.N.
National Cancer Institute, Bethesda, MD 20892

2 References

1. 1

   Longo DL, Glatstein E, Duffey PL, et al. Radiation therapy versus combination chemotherapy in the treatment of early-stage Hodgkin's disease: seven-year results of a prospective randomized trial. J Clin Oncol 1991;9:906-917
   Web of Science | Medline

2. 2

   Biti GP, Cimino G, Cartoni C, et al. Extended-field radiotherapy is superior to MOPP chemotherapy for the treatment of pathologic stage I-IIA Hodgkin's disease: eight-year update of an Italian prospective randomized study. J Clin Oncol 1992;10:378-382
   Web of Science | Medline