SAN DIEGO (EGMN) – New results from a study presented at the annual meeting of the American Society of Hematology suggest that standard chemotherapy alone is more effective than radiation therapy in increasing survival in patients with low-stage nonbulky Hodgkin’s lymphoma in the long term. In this study, Ralph M. Meyer, MD, PhD, head of the Clinical Trials Group at the National Cancer Institute of Canada, and colleagues randomized 405 patients with previously untreated stage IA or IIA non-bulky Hodgkin’s lymphoma to receive ABVD alone [adriamycin, blenoxane, vincristine ( Velbe) and dacarbazine] chemotherapy, and the other group received subtotal lymph node irradiation (at a dose of 35 Gy once daily for 20 d). Low-risk patients in the radiotherapy group received irradiation only, whereas high-risk patients received 2 cycles of ABVD chemotherapy followed by radiotherapy. The median follow-up time was 11.3 years. Although the 5-year data showed better disease control in the radiotherapy group, mortality due to other causes was lower in the chemotherapy group, reflecting the advantage of chemotherapy in improving survival. at 12 years, the survival rates were 94% and 87% in the chemotherapy and radiotherapy groups, respectively [hazard ratio (HR)=0.50 for death; P=0.04]. at 12 years, the disease-free progression rates in the radiotherapy and chemotherapy groups were 92% and 87% (HR=1.91; P=0.05,) and event-free survival rates were 80% and 85% (HR=0.88; P=0.60), respectively. Twelve patients in the chemotherapy group died: six from Hodgkin’s lymphoma, four from other cancers, and two from cardiac events. In contrast, 10 of the 24 patients in the radiotherapy group who died died died from other cancers, 2 from cardiac events, 4 from Hodgkin’s lymphoma, 3 from lethal infections, and 5 from other causes. The investigators said that the interpretation of the study’s results may be controversial because the use of subtotal lymph node irradiation in clinical practice has now tended to decrease. The study clearly demonstrates that disease control metrics (e.g., absence of disease progression) are not accurate proxies for long-term overall survival in patients with stage I-II non-massive Hodgkin lymphoma, and therefore new proxies that predict long-term outcomes need to be further explored.