CHEMOTHERAPY-RADIOTHERAPY SEQUENCE IN THE MANAGEMENT OF HODGKINS-DISEASE - RESULTS OF A CLINICAL-TRIAL

One hundred and thirteen patients with clinically supradiaphragmatic Hodgkin's disease were consecutively treated between April 1972 and December 1975 using a randomized chemotherapy-radiotherapy program (H 72 02). Both branches of this program had chemotherapy (MOPP) prior to irradiation; but in the branch S1 laparotomy was performed before chemotherapy and in the branch S2, after chemotherapy. Staging laparotomy (trial S1) showed that the rate of initial subdiaphragmatic involvement was around 45%. Restaging laparotomy (trial S2) performed on patients put into complete remission by 6 courses of MOPP therapy showed that 92% of the patients were free of subdiaphragmatic involvement. When staging or restaging laparotomy was negative, no subdiaphragmatic irradiation was performed. The rate of survival and disease free survival at 3 yr was around 95%. This proves that prior chemotherapy is able to sterilize occult subdiaphragmatic involvement of the disease, thereby avoiding in most cases unnecessary subdiaphragmatic irradiation. © 1979.