Contribution of Three-dimensional Conformational Radiotherapy with Modulation of Intensity (IMRT) for Women Affected by Stage II Supradiaphragmatic Hodgkin's Disease: A Dosimetric Study Comparing IMRT by Tomotherapy and a Three-dimensional Conformational Radiotherapy (3D-CRT)

From 1979 to 1986, the response to treatment of 53 patients with stage IA to IIB mediastinal Hodgkin's disease was evaluated by three-dimensional volumetric analysis using thoracic computed tomographic (CT) scans. The mean initial volume of mediastinal disease in 34 patients treated with mantle and para-aortic irradiation was 166 mL, whereas for 19 patients treated with two to six cycles of multiagent chemotherapy and mantle and para-aortic irradiation the mean initial volume was 446 mL. Preliminary data suggested that patients with mediastinal volumes of less than 200 mL had a lower mediastinal relapse rate (13%) than patients with volumes greater than 200 mL (32%). For 12 patients receiving six cycles of nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP), those with a greater than 85% reduction in volume 1 to 2 months after chemotherapy had a lower incidence of mediastinal relapse (zero of six, 0%) compared with patients having 85% or less reduction in volume (four of six, 67%). The primary value of this technique is that it provides a sensitive assessment of response to treatment and may aid in monitoring the effectiveness of a given treatment.

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The Evaluation of Fibrinogen Behavior in Hodgkin's Disease: Correlation with Clinical Stage

Tumori Journal ◽

10.1177/030089168306900207 ◽

1983 ◽

Vol 69 (2) ◽

pp. 123-127

Author(s):

Vittorio Pengo ◽

Giuseppe Cartei ◽

Dario Casara ◽

Otello Daniele ◽

Mario V. Fiorentino

Keyword(s):

Complete Remission ◽

Hodgkin's Disease ◽

Half Life ◽

Degradation Products ◽

Hodgkin’S Disease ◽

Clinical Stage ◽

Stage Iv ◽

Stage Ii ◽

Control Group ◽

Coagulation Disorder

Forty-four patients (9 stage II, 15 sage III, 7 stage IV, and 13 in complete remission) with Hodgkin's disease without any clinical coagulation disorder were studied. Fibrinogen behavior was evaluated by measuring fibrinogen level and using 1251-fibrinogen, the half-life, survival and fibrinogen turnover. Platelet count and fibrinogen/fibrin degradation products (FDP) were also assayed. The fibrinogen half-life, survival and turnover were significantly longer and faster, than those found in 10 healthy subjects, in stage II, III and IV subjects (p < 0.001, p < 0.001, p < 0.05 for stage II; p < 0.001, p < 0.001, p < 0.001 for stage III; p < 0.005, p < 0.005, p < 0.001 for stage IV, respectively). In most cases, FDP values were within the normal range, although they were significantly higher than those of control group in stages III and IV. Intravascular coagulation and fibrinolysis were not found in the 13 patients with complete remission. In these patients, the behavior of fibrinogen was normal, suggesting that the parameters studied are related to the presence of the tumor, and can be useful in monitoring the state of remission.

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Feasibility of Different Combinations of Chemotherapy (6 MOPP) plus Radiotherapy in Hodgkin's Disease

Tumori Journal ◽

10.1177/030089167906500609 ◽

1979 ◽

Vol 65 (6) ◽

pp. 729-741

Author(s):

Fabio Volterrani ◽

Roberto Zucali ◽

Davide Sigurtà ◽

Aldo Severini ◽

Armando Santoro

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Combined Treatment ◽

Objective Response ◽

Lymph Node Involvement ◽

Pulmonary Complications ◽

Stage Ii ◽

Stage Iii ◽

Wide Field ◽

Fitting In

During a preliminary clinical experience (1973-1977) we experimented three different sequences in associating 6 MOPP cycles (CT) with radiotherapy (RT) for the treatment of stage II and III Hodgkin's disease. A total of 55 consecutive previously untreated patients can be estimated to contribute in defining feasibility, immediate results and toxicity of the combined treatment. In this group of patients RT preceded CT in 20 cases (RT-6 MOPP), the opposite sequence (6 MOPP-RT) was preferred in 16 cases, whilst a split-course CT fitting in the RT (3 MOPP-RT-3 MOPP) was employed in 19 cases. Except for the sequence used with respect to irradiation, the CT was carried out in all the cases according to the classical scheme proposed by De Vita et al. (11). RT was effected with 60Co-teletherapy and a wide field or segmental sequential fields, having variable extension depending on the stage (« extended nodal irradiation » for stage II and III cases with lymph node involvement not below L3; « total nodal irradiation » for the remaining cases in stage III). The programmed doses were 45.0 Gy to the involved areas and 40.0 Gy to the clinically uninvolved regions for the RT-6 MOPP and 6 MOPP-RT groups. Doses of 35.0/30.0 Gy were planned for the 3 MOPP-RT-3 MOPP group. The three different groups are not homogeneous with regard to certain important clinical and pathological characteristics; in fact, a higher quota of stage III patients, with systemic symptoms and spleen positivity is present in the 6 MOPP-RT and 3 MOPP-RT-3 MOPP groups. The combined treatment has achieved a complete clinical remission in 18/20 patients in the RT-6 MOPP group (90.0 %), in 12/16 patients of the 6 MOPP-RT group (75.0%), and in 17/19 cases in the 3 MOPP–RT-3 MOPP « sandwich » combination (89.5%). The average overall duration of the treatment was 48 weeks for the sandwich combination, 50 weeks for the RT-6 MOPP group, and 56 weeks for the 6 MOPP-RT association. As regards the sandwich combination, both CT and RT took a reasonable length of time to complete. On the contrary, both the medical treatment and irradiation required an excessively long time and were not well tolerated when preceded by either RT or CT in full doses. In particular, myelosuppression was less acute and prolonged in the 3 MOPP-RT-3 MOPP group, whereas the actual doses of CT and RT were higher than those which can be reached with respect to other groups. Three preliminary cycles of CT considerably reduce the target volumes and complications arising from RT. The first CT time gave an objective response ≥ 50 % in 9/9 cases of the 3 MOPP-RT-3 MOPP group with mediastinal involvement. In this group, rather considerable pulmonary complications were observed in 3/9 patients (33.3 %) with respect to the 40 % found for the 6 MOPP-RT group (2/5 cases) and the 67.7 % for the RT-6 MOPP group (6/9 cases).

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