Alternating chemotherapy and radiation therapy in the treatment of advanced Hodgkin's disease.

During the period from 1982 to 1987, 19 patients with advanced Hodgkin's disease, clinical stages IIIB and IV underwent treatment with combination chemotherapy and radiotherapy. Alternating chemotherapy (3 cycles of CVCPP/3 cycles of ABVD) was sandwiched with low-dose total nodal irradiation including the splenic area; at the end of the chemotherapy, a supplemental 20 Gy radiotherapy was sometimes delivered to bulky previously involved sites. The complete remission rate was 84.2% (16/19 patients) and actuarial survival was 85% at 48 months. These preliminary results show that the alternating technique for combining chemotherapy and sandwiched irradiation is feasible and improves the outcome in advanced Hodgkin's disease. Patients with mediastinal masses associated with pulmonary and/or pleural involvement may need more aggressive chemotherapy at an earlier phase of the treatment program.