***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND We concluded a program in which we administered radiotherapy only to clinical stages I and II Hodgkin 's disease patients at st and ard risk , with the addition of 4 cycles of combination chemotherapy before radiotherapy for high-risk patients . PATIENTS AND METHODS From 1980 to 1991 , 313 patients with clinical stages I or II Hodgkin 's disease underwent treatment in our hospital . Fifty percent of the patients in groups previously identified as being at high risk for relapse received 4 cycles of combination chemotherapy before radiotherapy . The remaining half of the patients received radiotherapy only . RESULTS Low- and high-risk patients aged 15 - 59 years had , respectively , complete remission ( CR ) rates of 97 % and 94 % , 5-year survivals of 95 % and 91 % , and 5-year freedom from relapse ( FFR ) rates of 78 % and 89 % . Older low- and high-risk groups had CR rates of 97 % and 93 % , 5-year survivals of 60 % and 56 % and 5-year FFR of 77 % and 93 % , respectively . CONCLUSION Here we present our favorable results after treating st and ard-risk patients with clinical stages I and II Hodgkin 's disease with radiotherapy only . With the addition of chemotherapy , the rate of relapse in the high-risk patients was reduced below that of the st and ard-risk patients . Overall survival was the same for the high- and st and ard-risk patients Abstract 57 patients with advanced Hodgkin 's Summary disease who entered a complete remission after chemotherapy with mustine ( nitrogen mustard ) , vincristine ( ' Oncovin ' ) , procarbazine , and prednisone ( M.O.P.P. )  were allocated at r and om to one of three regimens — no additional therapy , intermittent therapy with M.O.P.P. , or intermittent therapy with 1,3-bis(2-chloroethyl)-1-nitrosourea ( B.C.N.U. ) . 24 % of those patients receiving no further therapy have relapsed , as have 25 % of those on intermittent M.O.P.P. and 13 % of those on intermittent B.C.N.U. ; the differences are not significant . The median duration of initial remissions will be > 48 months for all the patients , and there is no significant difference between the individual groups . Complications and infections were more frequently seen in the patients receiving maintenance therapy , especially in those on B.C.N.U. Only 1 patient in each of the three groups has died of Hodgkin 's disease , and survival is not significantly influenced by maintenance therapy . The projected 5-year survival for the entire group of patients is 86 % PURPOSE At present , treatment results for patients with advanced-stage Hodgkin 's disease remain unsatisfactory . St and ard chemotherapy M(C)OPP ( nitrogen mustard ( cyclophosphamide ) . vincristine , procabazine , and prednisone ) . ABVD ( adriamycine , bleomycine , vinblastine , and dacarbacine ) or M(C)OPP/ABVD + /- radiotherapy fail to achieve long-term complete remission in 35 % to 50 % of these patients . The BEACOPP ( bleomycin , etoposide , adriamycine , cyclophosphamide , vincristine , procarbazine , and prednisone ) regimen was developed to improve treatment results by dose intensification achieved by reduced duration of treatment ( time intensification ) and addition of etoposide . PATIENTS AND METHODS Thirty untreated patients with advanced Hodgkin 's disease stage IIB IV according to the Ann Arbor classification were treated with the time intensified BEACOPP regimen . Each patient was scheduled to receive eight cycles of chemotherapy with consolidating radiotherapy to sites of initial bulk disease and to residual tumor remaining after chemotherapy . RESULTS All patients were evaluable for assessment of toxicity , treatment response , freedom from treatment failure ( FFTF ) and survival ( SV ) . Of 30 treated patients , 29 patients received the intended eight cycles of BEACOPP . One patient in clinical CR , terminated the chemotherapy at his own request after six cycles and is at this time , 48 months after the end of treatment , in complete remission . Toxicity was tolerable with WHO grade 3/4 leucopenia in 28 % of chemotherapy cycles and one severe ( WHO grade 3 ) infection . No treatment-related death occurred . Cycles could generally be given on schedule . Complete remission ( CR ) was achieved in all but two patients ( 93 % ) . At present , only one patient has relapsed . At a median follow-up of 40 months , FFTF-rate is 89 % ( lower confidence limit : 80 % ) . One patient died due to progressive disease . CONCLUSION The BEACOPP regimen is feasible at moderate hematopoeitic toxicity . With a FFTF-rate of 89 % at a median follow-up of 40 months , the treatment results are very encouraging . A prospect i ve r and omised trial has been initiated to compare the BEACOPP regimen with the st and ard COPP/ABVD regimen in advanced-stage Hodgkin 's disease PURPOSE To evaluate two regimens of chemotherapy followed by high dose total or subtotal nodal irradiation in advanced Stages of Hodgkin 's disease . METHODS AND MATERIAL S From October 1980 to September 1985 , 70 patients with Hodgkin 's disease , with clinical Stages IIIB ( 35 cases ) and IV ( 35 cases ) were treated with combined modality therapy .  Patients were r and omly assigned to receive four cycles of chemotherapy , mechlorethamine , vincristine , procarbazine and prednisone ( MOPP ) versus the same regimen alternating with adriamycin , bleomycin , vinblastine and dacarbazine , ABVD-derived regimen , followed by high-dose ( 40 Gy ) total or subtotal nodal irradiation . Because of partial response , 13 patients ( 18.5 % ) got additional chemotherapy ( 1 - 4 cycles ) . RESULTS After chemotherapy , 49 patients ( 70 % ) achieved complete remission or good partial response and 15 patients ( 21.5 % ) partial response . Five primary failures ( 7 % ) and one death ( 1.5 % ) occurred . After combined modality therapy , 59 patients ( 84 % ) achieved complete remission , one patient partial response ( 1.5 % ) and eight patients ( 11.5 % ) failed to primary treatment . Two toxic deaths ( 3 % ) were observed during initial treatment . There was no significant difference in response rates between MOPP/radiotherapy and MOPP/ABVD/radiotherapy . Nine patients relapsed ( 15 % ) . A total of 21 patients died , 13 because of Hodgkin 's disease and eight from other causes . High dose total or subtotal nodal irradiation following four courses of chemotherapy was feasible , although hematological toxicity grade > or = 2 ( World Health Organization ) was observed in one-third of the patients , particularly in patients aged over 40 . The median duration of follow-up was 75 months . Actuarial survival curves indicate a 8 years disease-free survival and survival of 70 % and 65 % respectively , without any significant difference between the two regimens . Because of hematological toxicity , the percentage of planned full treatment was lower in MOPP/radiotherapy regimen . CONCLUSION These results lead to recommend the alternating regimen . Patients restaged as poor responders after initial chemotherapy did not survive for long . More intensive treatment is now proposed for this subgroup of patients From 1964 to 1987 , the EORTC Lymphoma Group conducted four consecutive controlled clinical trials on clinical stages I and II Hodgkin 's disease in which 1,579 patients were entered . From the onset the main aim of these trials was to identify the subsets of patients who could be treated safely by regional radiotherapy ( RT ) .  Therefore , several prognostic indicators were prospect ively registered and progressively used in the trial protocol s for the delineation of the favorable and unfavorable subgroups as soon as they were recognized of high predictive value . In the H2 trial ( 1972 to 1976 ) , the histologic subtype was the only variable taken into account for the therapeutic strategy and the staging laparotomy findings were found to be of prognostic value only in patients with favorable prognostic indicators . In the H5 trial ( 1977 to 1982 ) , patients were subdivided into two subgroups according to six prognostic indicators . Patients with favorable features were su bmi tted to a staging laparotomy ( lap ) ; lap negative patients were r and omized between mantle field RT and mantle field plus paraaortic RT . Disease free survival ( DFS ) and total survival ( S ) were similar in the two arms . Among patients with unfavorable features , DFS and S were significantly higher in the arm treated by combination of mechlorethamine , vincristine , procarbazine , prednisone ( MOPP ) chemotherapy ( CT ) and RT than in the arm treated by total nodal irradiation . Nevertheless , in patients below the age of 40 , the overall survival rates were equivalent in the two arms . In the H6 trial , the delineation of the favorable subgroup was based on ( a ) absence of systemic symptoms and elevated ESR , ( b ) no more than one or two lymph node areas involved . The aim of the study was to assess the impact on survival of a therapeutic strategy including staging laparotomy . At a 4-year follow-up , no difference in survival was evidence d. In patients with unfavorable prognostic indicators , 3 MOPP-RT-3 MOPP were compared with 3 ABVD-RT-3 ABVD . From H1 to H5 trials , the proportion of patients having received CT  during the course of the disease gradually decreased ; the data suggest that a further reduction in the proportion of patients aggressively treated is conceptually possible . On the basis of the prognostic factors identified , one can delineate three subsets of patients and modulate toxic cost of the initial treatment according to the characteristics of these subsets . In the most favorable subgroup , RT alone produces high survival and CT is not justified . ( ABSTRACT TRUNCATED AT 400 WORDS One hundred and fourteen untreated patients with pathological stage ( PS ) IA-IIB supradiaphragmatic Hodgkin 's Disease were r and omised to mantle radiotherapy alone ( 55 ) or mantle radiotherapy followed by 6 courses of adjuvant chemotherapy with mustine , vinblastine , prednisolone and procarbazine- MVPP ( 59 ) . Patients excluded were those outside the age range 16 - 65 years and those with massive mediastinal disease precluding laparotomy . Bulk disease was defined as a mass of lymph nodes measuring five centimetres or more in any axis . Mediastinal bulk was present if the ratio of the maximum width of mediastinal disease to the maximal chest diameter was more than one third . All patients achieved a complete remission . Median duration of follow-up was 62 months ( range 16 - 97 ) . The relapse free survival ( RFS ) was 81 % ; 69 % for radiotherapy alone and 93 % for adjuvant chemotherapy ( P = 0.002 ) . RFS was also shown to be adversely affected by B symptoms ( P = 0.0003 ) , bulk disease ( P = 0.018 ) , abnormal CXR ( P = 0.037 ) , and increasing stage ( P = 0.039 ) . Age , sex , histology , and number of sites involved had no significant effect upon RFS . A Cox multivariate analysis showed that only three variables had a significant adverse effect on RFS - radiotherapy alone , the presence of bulk disease , and B symptoms . The overall 5 year survival was 93 % with no statistically significant difference between the two treatment groups ( P = 0.54 ) . Survival was adversely affected by three variables - B symptoms ( P = 0.02 ) , the presence of bulk disease ( P = 0.002 ) , and pathological stage ( P = 0.05 ) . High risk groups for relapse are those with bulk and B symptoms . This analysis has shown that RFS was significantly improved by adjuvant chemotherapy , but that overall survival was not High-dose chemotherapy with autologous bone marrow transplantation is used in the treatment of relapsed or high-risk Hodgkin 's disease . As prospect i ve r and omised studies have proved difficult to accrue to , current recommendations are based on the reports of large series of prospect ively collected data . We have looked at the outcome of 89 patients treated in this way at a single institution and have developed an index to predict outcome . Of 89 patients , with a median age of 29 years ( range 15 - 51 years ) , eight patients were in first complete remission/partial remission ( CR/PR ) , 17 in second or later CR , 37 were responding relapses , 13 resistant relapses , 11 primary refractory and three untested relapses . Combinations of melphalan , BCNU and etoposide were given in all cases except in ten patients who received melphalan alone . The median follow-up was 43 months ( range 6 - 77 months ) . A total of 24 patients were in CR at the time of autologous bone marrow transplantation ( ABMT ) , 33 achieved CR with ABMT , 16 PR , to give a response rate to ABMT of 49/65 = 74 % ( 95 % 
    Output:
    
For the majority of patients with relapse after radiotherapy , chemotherapy is curative and the total proportion of cured early stage patients is 75 - 90 % .
Chemotherapy in addition to extended field radiotherapy reduces recurrences but does not improve long-term survival .
It is likely that chemotherapy will play a greater role in the future in the treatment also of early stage patients in order to reduce late consequences from extended field radiotherapy .
Several chemotherapy regimens containing four to eight drugs are effective in HD .
The results of chemotherapy are more favourable in young than in elderly patients .
Persistent side-effects of treatment are common among long-term survivors , although most patients have an apparently normal life .