Influence of clinical trials on current treatment strategy for Hodgkin's disease

This paper critically reviews the prospective randomized trials conducted over the past three decades in Hodgkin's disease of adults. On the basis of current findings, it is difficult to conclude which randomized trials were influential in defining widely accepted treatment strategies or treatment sequencies, as many studies were poorly conceived and/or executed. However, other reasons may have come into play. The treatment decision making of Hodgkin's disease involves a complex mosaic of prognostic factors and therefore of potentially successful treatment options. Although irradiation and chemotherapy are both effective in different stages, their optimal integration in a multi-disciplinary approach remains to be assessed. Over the years, different research philosophies were translated into different study designs for each stage or patient subset, and in some instances multiple treatment approaches represented a confounding factor in the search for true and reliable prognostic variables. Also, by the time a given trial became mature enough to provide meaningful results, other single arm or randomized studies were undertaken, often yielding premature data. Thus, the instability of treatment results from preliminary analyses can influence subsequent trial design and engender perplexity among physicians. Prospective randomized trials remain today the most reliable tool to assess in Hodgkin's disease the cost benefit ratio of given treatments in clearly identifiable prognostic subsets.