571 favorable CS I-II pts. randomized to ABVD X 2 + EF vs EF alone

2y FFP better in combo arm: 96% vs 84%, (P < 0.05). 2y OS 98% vs 98%

Bonadonna 20 2004 136 limited stage randomized to ABVD X No difference in FFP or OS

Bonadonna 20 2004 136 limited stage randomized to ABVD X No difference in FFP or OS

FFP, freedom from progression; CS, clinical stage; IF, involved field; EF, extended field; XRT, radiation therapy; STLI, subtotal lymphoid irradiation.

these three groups are as follows: for the favorable group, the recommendation is for subtotal lymphoid irradiation alone or CMT; for the group with bulky disease, CMT is recommended; for the nonbulky group with other high risk factors, either CMT (preferred) or subtotal lymphoid irradiation therapy is recommended. None of these recommendations for limited stage HL include chemotherapy alone.

Two recent studies have explored the use of ABVD alone for limited stage HL. A Canadian trial randomized 399 patients with nonbulky stage I-IIA disease, comparing four to six cycles of ABVD chemotherapy with extended field radiation therapy (in a high-risk group), or to two cycles of ABVD plus extended field radiation therapy (in a low-risk group). Five-year freedom from progression was slightly inferior in the ABVD group (87% vs 93%, P = 0.006). OS was the same, 96% (ABVD) versus 94% (standard therapy).22 Strauss et al. studied 152 untreated clinical stage I-IIIA non-

bulky HL, comparing outcome to either six cycles of ABVD, or six cycles of ABVD followed by radiation therapy (involved-field or extended-field).23 With five years follow-up, there was no difference in freedom from progression, or OS, in the two arms. Much smaller series have also described the clinical utility of ABVD alone in limited stage HL.2425

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