Recent trials of CMT

A sample of the recently reported randomized trials of limited stage HL is shown in Table 73.3. The usual design of the studies is a comparison of extended field radiation therapy versus abbreviated chemotherapy, combined with either limited or extended field radiation therapy. In three studies, the control group was extended field radiation therapy and abbreviated courses of chemotherapy were given with either extended-field radiation therapy or IFRT. Freedom from progression was improved in the combined modality group in all three trials; OS was identical. Bonadonna et al. investigated the use of four full cycles of ABVD chemotherapy followed by either IFRT or extended-field radiation therapy. No differences in 12-year freedom from progression or OS were noted.

All of this data has lead to the National Comprehensive Cancer Network (NCCN) practice guidelines for limited stage HL to focus on the use of extended field radiation therapy alone or CMT.21 For clinically staged patients with supradiaphramatic presentation, the most common presentation of limited stage HL, the NCCN practice guidelines focused on three patient groups: those with no unfavorable factors, those with bulky disease, and those with nonbulky disease with an erythrocyte sedimentation rate (ESR) greater than 70 or three sites involved. The recommendations for

Table 73.3 Recent limited stage HL randomized trials

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