Cost-effectiveness of Routine Computerized Tomography in Follow-up of Patients with Complete Response After Primary Treatment for Hodgkin’s Disease

Thirteen patients who had relapsed or failed to obtain a complete remission after combination chemotherapy for the treatment of advanced Hodgkin's disease were treated with subtotal or total lymphoid irradiation with curative intent. Twelve of the 13 patients achieved a complete response (CR). Five of the 12 CRs subsequently relapsed at 3, 9, 9, 12, and 19 months. One patient died of leukemia 11 months following radiotherapy. The actuarial relapse-free survival at 1 year was 60%, and six patients (50%) remain disease-free with a median follow-up of 34 months (range, 10 to 115 months) following the completion of radiotherapy. Patients who failed to obtain a CR to their initial chemotherapy, whose chemotherapy CR was of short duration, or who relapsed initially in extranodal sites, tended to have a worse outcome with radiotherapy. Patients who had long disease-free intervals after initial chemotherapy or relapsed only in nodal sites tended to do relatively well. Radiation therapy was well tolerated with no major toxicity. Potentially curative radiation therapy should be considered an option in the management of selected patients who relapse following combination chemotherapy for advanced Hodgkin's disease.

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MOPP/ABV hybrid program: combination chemotherapy based on early introduction of seven effective drugs for advanced Hodgkin's disease.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.9.1174 ◽

1985 ◽

Vol 3 (9) ◽

pp. 1174-1182 ◽

Cited By ~ 116

Author(s):

P Klimo ◽

J M Connors

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Complete Response ◽

New Disease ◽

Duration Of Treatment ◽

Actuarial Survival ◽

Early Introduction ◽

Hybrid Program ◽

Advanced Hodgkin’S Disease

Seventy patients with advanced Hodgkin's disease, 54 with new disease, and 16 in first relapse after initial radiotherapy, have been treated with a seven-drug, 8-month program: MOPP (nitrogen mustard, vincristine, procarbazine, prednisone)/ABV (Adriamycin [Adria Laboratories of Canada, Mississauga, Ontario], bleomycin, vinblastine) hybrid. A single involved field of radiotherapy was given to selected partial responders after 6 months of chemotherapy. Forty-six of the 52 (88%) evaluable new-disease patients and 14 of the 16 (87%) evaluable patients with relapsing disease reached a complete response. The actuarial overall survival at 49 months for the patients with new disease was 90% (median follow-up from diagnosis was 27 months). For the patients with relapsing disease, the actuarial survival at 54 months was 79% (median follow-up from diagnosis was 27 months). The actuarial relapse-free survival at 41 months for complete responders was 93% for patients with new disease (median follow-up after treatment was 20 months) and 80% for those with relapsing disease (median follow-up after treatment was 27 months). Toxicity was moderate, with two treatment-related deaths and eight episodes of serious infection. These results compare favorably with the best results reported in the literature. Furthermore, they were achieved with a moderate level of toxicity, high drug delivery rates, and a relatively short duration of treatment. The efficacy and toxicity data of the MOPP/ABV hybrid program will now be evaluated in a prospectively randomized multicenter study.

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Chemotherapy as a primary treatment of Hodgkin's disease (204 new cases, 1 to 8 years of follow-up)

European Journal of Cancer (1965) ◽

10.1016/0014-2964(75)90041-9 ◽

1975 ◽

Vol 11 (10) ◽

pp. 679-688 ◽

Cited By ~ 1

Author(s):

Cl. Jacquillat ◽

M. Weil ◽

G. Auclerc ◽

J.P. Desprez-Curely ◽

C. Chastang ◽

...

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Primary Treatment

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Cost-Effectiveness Analysis of Computerized Tomography in the Routine Follow-Up of Patients After Primary Treatment for Hodgkin’s Disease

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.0409 ◽

2006 ◽

Vol 24 (25) ◽

pp. 4116-4122 ◽

Cited By ~ 51

Author(s):

Beverly A. Guadagnolo ◽

Rinaa S. Punglia ◽

Karen M. Kuntz ◽

Peter M. Mauch ◽

Andrea K. Ng

Keyword(s):

Cost Effectiveness ◽

Life Expectancy ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Sensitivity Analyses ◽

Old Patients ◽

Asymptomatic Patients ◽

Life Years ◽

Quality Adjusted Life

Purpose To estimate the clinical benefits and cost effectiveness of computed tomography (CT) in the follow-up of patients with complete response (CR) after treatment for Hodgkin’s disease (HD). Patients and Methods We developed a decision-analytic model to evaluate follow-up strategies for two hypothetical cohorts of 25-year-old patients with stage I-II or stage III-IV HD, treated with doxorubicin, bleomycin, vinblastine, and dacarbazine-based chemotherapy with or without radiation therapy, respectively. We compared three strategies for observing asymptomatic patients after CR: routine annual CT for 10 years, annual CT for 5 years, or follow-up with non-CT modalities only. We used Markov models to calculate life expectancy, quality-adjusted life expectancy, and lifetime costs. Baseline probabilities, transition probabilities, and utilities were derived from published studies. Cost data were derived from the Medicare fee schedule and medical literature. We performed sensitivity analyses by varying baseline estimates. Results Annual CT follow-up is associated with minimal survival benefit. With adjustments for quality of life, we found a decrement in quality-adjusted life expectancy for early-stage patients followed with CT compared with non-CT modalities. Sensitivity analyses showed annual CT for 5 years becomes more effective than non-CT follow-up if the specificity of CT is 80% or more or if the disutility associated with a false-positive CT result is less than 0.01 quality-adjusted life years (QALYs). For advanced-stage patients, annual CT for 5 years is associated with a very small quality-adjusted survival gain over non-CT follow-up with an incremental cost-effectiveness ratio of $9,042,300/QALY. Conclusion Our analysis suggests that routine CT should not be used in the surveillance of asymptomatic patients in CR after treatment for HD.

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Twenty years of MOPP therapy for Hodgkin's disease.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.9.1295 ◽

1986 ◽

Vol 4 (9) ◽

pp. 1295-1306 ◽

Cited By ~ 316

Author(s):

D L Longo ◽

R C Young ◽

M Wesley ◽

S M Hubbard ◽

P L Duffey ◽

...

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Large Cell ◽

Complete Response ◽

Results Of Treatment ◽

End Of Treatment ◽

Hodgkin's Lymphomas ◽

Higher Doses ◽

Disease Free

The results of treatment of 198 patients with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) for Hodgkin's disease were analyzed after a median of 14 years of follow-up. Throughout the period of follow-up, 103 patients have remained continuously free of disease. Review of biopsy specimens of 43 patients originally classified as Hodgkin's disease, lymphocyte-depleted type, revealed that ten of these patients actually had diffuse immunoblastic or large cell non-Hodgkin's lymphomas. Of the 188 patients with Hodgkin's disease, 157 achieved a complete response (CR) (84%), and 66% of them (101 patients) have remained disease-free more than 10 years from the end of treatment. Absence of B symptoms and receiving higher doses of vincristine were factors associated with a higher CR rate and longer survival. Patients entering complete remission in five cycles or less had significantly longer remissions than those requiring six or more cycles. Forty-eight percent of the Hodgkin's disease patients have survived between 9 and 21 years (median, 14 years) from the end of treatment. Nineteen percent of the CRs have died of intercurrent illnesses, free of Hodgkin's disease.

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