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Extended-Field Radical Radiotherapy in Advanced Hodgkin's Disease: Short-Term Results of 2 Randomized Clinical Trials¹

Departments of Radiology and Medicine, Stanford University School of Medicine, Palo Alto, California

The 2 clinical trials described herein were initiated in 1962 with the following objectives: (a) to determine whether intensive prophylactic irradiation of apparently uninvolved lymph node regions adjacent to clinically involved regions in patients with regionally localized Hodgkin's disease increases the duration of remission and of survival; (b) to determine whether potentially curative doses of radiation given to patients with generalized Hodgkin's disease are more effective than palliative doses, as measured by length of remission and/or survival; (c) to accumulate additional information on the natural history of Hodgkin's disease in patients whose clinical stage was, in all instances, determined with the aid of lymphangiography and other special diagnostic procedures; (d) to evaluate the tolerance of normal tissues in patients treated with extended-field, high-dose radiations.

Patients who met the defined eligibility criteria were assigned to alternative treatment groups at random after an extensive diagnostic evealuation, which included lymphangiography, open bone marrow biopsy, and a battery of liver function tests, as well as other, more routine procedures in all cases. All patients were carefully examined at serial intervals, following completion of the defined radiotherapeutic program. Follow-up intervals are not yet long enough to permit evaluation of comparative survival in the various treatment groups. However, it is clear that extended-field megavoltage radiotherapy to doses in the range of 4000 rads, given at the rate of about 1000 rads/week, is surprisingly well tolerated; there have been virtually no major complications, and most of the observed hematologic, respiratory, neurologic, and endocrine complications have been relatively mild and transient in nature.

¹ These investigations have been supported by Grant CA 05838 from the National Cancer Institute, NIH. An earlier report was presented at a symposium on Hodgkin's disease held on February 15, 1965, at the Hôpital Saint-Louis, Paris, France, and will appear in French translation in a forthcoming issue of the Nouvelle Revelle Revue Française d'Hématologie.