Stage III nodular lymphomas: Preliminary results of a combined chemotherapy/radiotherapy program

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Abstract
Since 1975, all histologic subtypes of Stage III and IIIE nodular lymphoma patients were treated with a combination of radiotherapy and multiple‐agent chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP‐Bleo). Fifty‐eight patients were treated through 1979. Treatment consisted of two cycles of CHOP‐Bleo alternating with sequential radiotherapy to clinically involved regions, and further CHOP‐Bleo to a total of ten cycles. Radiotherapy doses ranged between 3000 and 4000 rad delivered in three to four weeks. Forty‐six patients completed treatment. In the other 12 patients, treatment was interrupted because of progressive disease in seven, and myelosuppression in five. Overall five‐year survival and disease‐free survival results were 82% and 47%, respectively. Survival for those patients who completed therapy was 93%. By histopathology, survivals for all patients were: poorly differentiated lymphocytic, 100%; mixed cell, 80%; and histiocytic, 39%. Disease‐free figures for all 58 patients were: poorly differentiated lymphocytic, 44%; mixed cell, 65%; and histiocytic, 35%. The extent of abdominal disease influenced five‐year survival as follows: 100% for those who had only occult disease at staging laparotomy; 88% for those who were Stage III on the basis of a positive lymphangiogram; and 50% for those who had a palpable mass or required an exploratory laparotomy for symptoms. Five of seven patients with progression during protocol therapy have died. No patients died as a result of myelosuppression. A number of patients developed complications during treatment, none of which were fatal. Eight patients developed herpes zoster, four patients developed transient radiation hepatitis, and four patients had miscellaneous complications.