Alternating chemotherapy and irradiation in the treatment of advanced Hodgkin's disease

From July 1974 through April 1977, 25 patients with stage IIIB or III/sub s/B Hodgkins disease were entered into a prospective trial to assess the efficacy of a new combined modality treatment program. Patients received either MOP(P) (nitrogen mustard, vincristine, procarbazine and prednisone) or PAVe (procarbazine, 1-phenylalanine mustard and vinblastine). The radiation fields were total lymphoid and the usual dose was 4000 to 4400 rad. Patients initially were treated in a split course fashion with six drug cycles sandwiched around total lymphoid irradiation. To minimize the time that patients were without systemic therapy and to maximize the doses of chemotherapy, an alternating approach was subsequently adopted. The total lymphoid fields were divided into three regions and treatment to each was alternated with 2 cycles of chemotherapy until the entire program was complete. The duration of therapy ranged from nine to eighteen months. Patients in the split course group received an average of 65% of their calculated total drug doses and those in the alternating group received an average of 76.5%. The primary complication was hematologic, with mean lowest recorded white cell count of 2200/mm3 and platelet count of 101,000/mm.3 Twenty-two of 25 patients achieved an initial complete remission and twenty remain free of disease with a median follow-up interval of 28 months. Actuarial survival for the entire group including a patient who died prior to the institution of therapy is 84%, while for those who achieved a complete remission it is 100%. Figures for freedom-from-relapse in the same groups are 79 and 90%, respectively. These results are compared to our previous experience using total lymphoid irradiation alone and total lymphoid irradiation followed by adjuvant MOP(P) chemotherapy. The alternating technique for combining chemotherapy and irradiation is feasible and provides a model for combined modality therapy in patients with other malignancies