Treatment of unfavorable childhood Hodgkin's disease with VEPA and low-dose, involved-field radiation

Alison M. Friedmann, Melissa M. Hudson, Howard J. Weinstein, Sarah S. Donaldson, Larry Kun, Nancy J. Tarbell, Michael P. Link

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Abstract

Purpose: Between January 1990 and April 1993, 56 pediatric patients with Hodgkin's disease were treated on a single-arm trial at three institutions with a regimen designed to maintain high cure rates while minimizing the potential late effects of treatment, such as infertility, second malignant neoplasms, and cardiopulmonary injury. Patients and Methods: The regimen used combined-modality therapy with six cycles of vinblastine, etoposide, prednisone, and doxorubicin (VEPA) chemotherapy and low-dose, involved-field radiation. Unfavorable features comprised bulky presentations of localized (stage I or II) disease or advanced (stage III or IV) Hodgkin's disease. Results: Of 56 patients enrolled, 26 (46%) had unfavorable presentations of stage I/II disease and 30 (54%) had advanced (stage III/IV) disease. Seventy-nine percent of the patients are alive without disease at a median follow-up time of 8.9 years from diagnosis. Nineteen patients had events at a median of 1.5 years (range, 0.4 to 7.9 years) from diagnosis; 17 patients relapsed, one died of cardiomyopathy, and one died of accidental injuries. Survival and event-free survival (EFS) estimates at 5 years for the entire cohort were 81.9% (SE, 5.2%) and 67.8% (SE, 6.3%), respectively. Five-year EFS by stage was 100% for stage I, 79.2% (SE, 8.3%) for stage II, 70% (SE, 14.5%) for stage III, and 49.5% (SE, 11.3%) for stage IV patients. Conclusion: Combined-modality therapy with VEPA chemotherapy and low-dose, involved-field radiation is adequate for disease control of early-stage patients with unfavorable features, but it is inferior to other standard regimens for advanced-stage patients.

Original languageEnglish (US)
Pages (from-to)3088-3094
Number of pages7
JournalJournal of Clinical Oncology
Volume20
Issue number14
DOIs
StatePublished - Jul 15 2002

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Friedmann, A. M., Hudson, M. M., Weinstein, H. J., Donaldson, S. S., Kun, L., Tarbell, N. J., & Link, M. P. (2002). Treatment of unfavorable childhood Hodgkin's disease with VEPA and low-dose, involved-field radiation. Journal of Clinical Oncology, 20(14), 3088-3094. https://doi.org/10.1200/JCO.2002.03.051