Simultaneous low-dose radiation and low-dose chemotherapy in the treatment of advanced Hodgkinʼs disease

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Abstract
(BCNU [1,3-bis(2-chloroethyl)-1-nitrosourea] 40 mg/m2), procarbazine 50 mg/m2, prednisone 40 mg/m2, and vincristine 1.4 mg/m2) with low-dose radiation therapy [(RT) 2000 rad] delivered to all areas of tumor involvement aside from the bone marrow was given to 28 patients with advanced Hodgkin''s disease. Upon completion of RT and CT, the BCNU and procarbazine was increased by 100% until a total of 6 cycles of CT (with and without RT) were given. Eleven patients had received prior CT [mechlorethamine, oncovin, nitrogen mustard, cytoxan, chlorambucil vinblastine, adriamycin, bleomycin and streptozotocin] and had not achieved complete remission (CR) or had relapse from CT-induced CR within 1 yr. Seventeen others had not had prior CT (7 had prior RT). Among the previously treated patients, 1 patient died in autopsy-proven CR during treatment. The other 10 patients achieved CR. Eight had relapsed at 4-36 mo. (median time to relapse, 6 mo.). Five patients died of Hodgkin''s disease, 3 others died of status asthmaticus and pneumonia, radiation pneumonitis, and acute nonlymphocytic leukemia, respectively. Three patients are still alive (2 in continuous CR) at 28, 89 and 90 mo. Among the previously untreated patients, 4 died during treatment 1 of acute myocardial infarction, 2 of liver failure, and 1 of radiation pneumonitis. Twelve of the other 13 patients achieved CR. One of the CR died of pneumonia and sepsis 3 mo. after completion of treatment; 2 other patients relapsed at 10 and 15 mo. Nine remain in continuous CR at 42-89 mo. of follow-up, (median follow-up, 81 mo.). Of 107 tumor areas treated with RT, in-field relapse occurred in 2 areas (1.9%). Hematologic tolerance to this treatment was good in both groups of patients. Radiation pneumonitis occurred in 50% of the patients whose lungs were irradiated, and it was fatal in 2. By design or for other reasons, the median and mean doses of BCNU and procarbazine given to previously treated patients were 62% and 65.2%, respectively. In untreated patients, the median and mean doses of these 2 agents were 66.6% and 61.4%, respectively. There were no differences in dosage of these 2 agents between patients who remain alive in CR and those who relapsed and died. The potential of similar programs of radiation and chemotherapy is discussed.