The key evidence for the use of this protocol comes from the EORTCr and German Hodgkin Study Group (GHSG)r trials.
The EORTC H8U trial involved 996 patients randomised into three regimens: six cycles of MOPP-ABV plus involved-field radiotherapy (reference group), four cycles of MOPP-ABV plus involved field radiotherapy, and four cycles of MOPP-ABV plus subtotal nodal radiotherapy.
The primary end point was event free survival. The secondary end points were overall survival and late severe complications.
After a median follow up of 92 months, the estimated 5 year event free survival was 84% after six cycles of MOPP-ABV plus involved field radiotherapy, 88% after four cycles of MOPP-ABV plus involved field radiotherapy and 87% after four cycles of MOPP-ABV plus subtotal radiotherapy. The 10 year overall survival estimates were 88%, 85%, and 84% respectively.r
Subsequently the HD11 trialr has shown that 4 cycles of ABVD followed by 30Gy involved field radiotherapy was equivalent to more intensive BEACOPP chemotherapy-radiotherapy regimens, and less toxic. However, dose reduction to 20Gy involved field radiotherapy was inferior to 30Gy with lower rates of freedom from treatment failure and progression free survival unless more intensive chemotherapy was used.
Figure 1: Kaplan-Meier curves for the four treatment arms.
A - 4x ABVD + 30Gy involved field RT (IFRT)
B - 4 x ABVD + 20Gy IFRT
C - 4 x BEACOPP + 30Gy IFRT
D - 4 x BEACOPP + 20Gy IFRT
© J Clin Oncol 2010 Eichr