Prognostic groups for management of localized Hodgkin's disease.

1985 ◽  
Vol 3 (3) ◽  
pp. 393-401 ◽  
Author(s):  
S B Sutcliffe ◽  
M K Gospodarowicz ◽  
D E Bergsagel ◽  
R S Bush ◽  
R E Alison ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Survival Rate ◽  
Relapse Rate ◽  
Hodgkin's Disease ◽  
Radiation Treatment ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Histologic Type ◽  
Type Group ◽  
Free Rate

Two hundred fifty-two patients receiving radical irradiation for clinical stages I and II Hodgkin's disease between 1968 to 1977 had an actuarial ten-year survival rate of 78% and a relapse-free rate of 61%. Sixty-seven patients receiving chemotherapy followed by radiation had a 78% survival rate and a 63% relapse-free rate. Independent prognostic factors for survival and relapse were age, stage, and histology. Disease bulk was predictive only of relapse. Neither site of presentation above or below the diaphragm nor presence of mediastinal involvement was predictive for survival or relapse; however, patients with large mediastinal masses (greater than or equal to 10 cm absolute diameter) had a significantly higher intrathoracic failure rate with conventional mantle irradiation. Analysis of failure, according to age, clinical stage, and histologic type, showed three groups of patients defined according to the risk of relapse with radiation therapy: those with isolated upper cervical stage IA disease (group 1, relapse rate 8%), younger patients with localized stages I and II disease of favorable histologic type (group 2, relapse rate 35%), and older patients with extensive or symptomatic stages I and II disease of less favorable histologic type (group 3, relapse rate 70%). Subsequent analysis of radiation treatment volume indicates that the use of upper abdominal irradiation for patients in group No. 2 could yield results equivalent to those achieved with radiation therapy for surgically staged patients.

Long-term Results of 100 Cases of Hodgkin's Disease treated with Chemoterapy

1967 ◽  
Vol 53 (2) ◽  
pp. 111-128 ◽  
Author(s):  
Sergio Di Pietro
Keyword(s):  
Survival Rate ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Long Term Results ◽  
Good Survival ◽  
Fourth Stage ◽  
X Ray ◽  
The Third

Long-term results of 100 cases of Hodgkin's disease, treated with chemotherapy associated or not with X-ray therapy from 1949 to 1900, are reported. The median, survival rate was of 36 months: at 5 years the rate was 25 %. The survival rate at 5 years was 34,2 % for the 38 women and 19.3 % for the 62 men treated. Of 66 cases of the third clinical stage 31.6 % was alive at 5 years; the corresponding value for the 40 cases of the fourth stage was 15 %. The best survival rate was observed in the group of women of the third clinical stage with involvement of ilo-mediastinic lymph nodes in the first period of the disease (52.6% at 5 years). As to the four histological varieties of our cases, one can observe that the «paragranuloma» and the «scleronodular» types show a fairly good survival rate, not depending on the clinical stage, whereas the «polymorphous» and «sarcomatous» ones cause a more severe prognosis for the patients of the fourth clinical stage. The age of the patients, evidence or not of « systemic » symptoms, and the duration of the disease before the first treatment don't seem to have any significant influence on the survival rate. The best results were obtained with chemotherapy-X-ray therapy association in the group of patients of the third stage (survival rate of 39.5 % at 5 years). No difference is noted, on the contrary, between long-term results of chemotherapy alone and those of chemotherapy associated with X-therapy in the fourth stage.

Improved survival in patients with limited stage IIIA Hodgkin's disease treated with combined radiation therapy and chemotherapy.

1994 ◽  
Vol 12 (12) ◽  
pp. 2567-2572 ◽  
Author(s):  
K C Marcus ◽  
L A Kalish ◽  
C N Coleman ◽  
L N Shulman ◽  
D S Rosenthal ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Survival Rates ◽  
Stage Iii ◽  
Combined Modality Treatment ◽  
Stage Iiia ◽  
Long Term Treatment

PURPOSE Patients with laparotomy-staged (PS) III 1A Hodgkin's disease confined to the upper abdomen are believed to have a favorable prognosis and require less aggressive treatment than patients with more-extensive stage III disease. We evaluated prognostic factors and outcome in 93 patients with PS III 1A Hodgkin's disease treated either with radiation therapy (RT) alone or combined RT and chemotherapy (combined modality treatment [CMT]) to determine the extent of treatment needed in this subgroup of stage IIIA patients. MATERIALS AND METHODS We retrospectively reviewed the freedom from relapse (FFR) rate, sites of recurrence, and survival rate of PS III 1A patients selected to receive extended-field irradiation (MPA, n = 27), total-nodal irradiation (TNI, n = 34), and CMT (n = 32) between 1969 and 1987. CMT consisted of six cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy and MPA. Patients treated with MPA were part of a prospective trial designed to reduce treatment to patients with minimal stage III disease with very favorable characteristics. RESULTS Histologic subclass and treatment were the only prognostic factors for FFR and survival rates. Patients with nodular sclerosis or lymphocyte predominance histology had significantly higher FFR and survival rates compared to patients with mixed-cellularity (MC) histology. The 10-year actuarial FFR of PSIII 1A patients treated with MPA was only 39%, versus 55% for TNI (P = .02) and 94% for CMT (v MPA, P < .0001; v TNI, P = .006). The patterns of recurrence in patients who received MPA and TNI were significantly different, with MPA patients relapsing more often in untreated pelvic or inguinal nodes, and TNI patients relapsing more often in extranodal sites with or without nodal sites. The 10-year actuarial overall survival rate for patients treated with CMT was 89% versus 78% for MPA (v CMT, P = .09) and 70% for TNI (v CMT, P = .05). CONCLUSION Patients with PSIII 1A Hodgkin's disease treated with RT have a significantly higher risk of relapse and potentially a poorer survival compared with patients treated with CMT. These findings suggest that CMT should play a greater role in the treatment of this favorable substage of patients. Management with modified chemotherapy and RT in an attempt to reduce long-term treatment-induced complications may be a preferred approach for future trials.

Malignant mesothelioma following treatment for Hodgkin's disease.

1996 ◽  
Vol 14 (7) ◽  
pp. 2098-2100 ◽  
Author(s):  
L B Weissmann ◽  
J M Corson ◽  
A I Neugut ◽  
K H Antman
Keyword(s):  
Radiation Therapy ◽  
Malignant Mesothelioma ◽  
Lung Tissue ◽  
Hodgkin's Disease ◽  
Radiation Treatment ◽  
Case Reports ◽  
Hodgkin’S Disease ◽  
Asbestos Exposure ◽  
Subsequent Development ◽  
Causal Link

PURPOSE Asbestos exposure is the major known risk factor for mesothelioma, but several case reports have suggested a link between radiation therapy and subsequent development of malignant mesothelioma. This report explores a possible association between radiation therapy for Hodgkin's disease and mesothelioma. PATIENTS AND METHODS Four cases of malignant mesothelioma were observed following Hodgkin's disease at the Mesothelioma Clinic of the Dana-Farber Cancer Institute. A fifth such patient was found after a review of the literature. RESULTS In all five cases, the mesothelioma arose in the field of prior radiotherapy. No history of asbestos exposure was elicited by careful questioning or by review of chest radiographs. Examination of lung tissue in one patient showed 250 ferruginous bodies per gram of lung tissue, consistent with no significant prior exposure. The mean interval between radiation treatment for Hodgkin's disease and development of mesothelioma was 15 years, which emphasizes the need for continued follow-up and evaluation of these patients and supports a causal relationship. CONCLUSION Mesothelioma may need to be added to the list of second malignancies that arise following radiation therapy for Hodgkin's disease. Further support is given to a causal link between radiation exposure and mesothelioma.

The Impact of Central Quality Assurance Review Prior to Radiation Therapy on Protocol Compliance: POG 9426, a Trial in Pediatric Hodgkin’s Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 753-753 ◽  
Author(s):  
Nancy P. Mendenhall ◽  
Josh Meyer ◽  
Jonathan Williams ◽  
Cameron Tebbi ◽  
Sandy Kessel ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Radiation Treatment ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Quality Assurance Program ◽  
Radiation Quality ◽  
Protocol Compliance ◽  
The Impact

Abstract Introduction. To reduce protocol non-compliance as a confounding variable impacting trial outcome, Pediatric Oncology Group (POG) mandated pre-radiation quality assurance review in POG 9426, a trial in pediatric early stage Hodgkin’s disease (HD). This report documents the impact of this quality assurance program. Patients and Methods. POG 9426 investigated response-based therapy in Stages IA, IIA, and IIIA1 HD without large mediastinal masses. Early complete responders to 2 cycles of ABVE received 25 Gy of radiation therapy (XRT) to involved field(s). Partial responders to 2 cycles of ABVE received 2 more cycles of ABVE before XRT. A minimum 2 cm XRT field margin was required on all imaged diseases, as a first step in the transition from historical standard XRT field design to image-based field design. Before XRT, initial and response imaging and XRT planning films were submitted for Pre-radiation Review (PR) at QARC. Treating radiation oncologists were notified within 24 hours as to whether plans were compliant or required revision. In some cases, multiple revisions were required. The 9426 Protocol Coordinators conducted a Final Review (FR) of protocol compliance at a later date. POG 9426 enrolled 294 patients, including 246 from 85 POG institutions and 48 from 33 CCG institutions. After the first 28 cases, the directorship of QARC changed. Forty-seven cases were invaluable (incomplete submission of data) and 31 patients were removed from study before XRT leaving a total of 216 patients with both PR and FR for analysis. Results. Thirty-nine of 53 (74%) cases from institutions exempt from the requirement for pre-radiation data submission and 137 of 163 (84%) cases from non-exempt institutions submitted data for PR, indicating widespread and voluntary compliance with centralized PR at Quality Assurance Review Center (QARC). Sixteen of 40 (40%) of cases not submitted for PR were judged major protocol violations at FR, compared with 23 of 176 cases (13%) subjected to PR. At PR, modifications to achieve protocol compliance were suggested in all but 40 cases. In only 19 were modifications not made, suggesting widespread willingness to change radiation field design to achieve protocol compliance. There were discrepancies between the PR and FR in 13 of the 176 cases. The causes for disparity were interpretation of “equivocal” disease (4), gross disease (5), and adequacy of margin (3), or difference in studies available for the two reviews (1). Five (39%) of the 13 disparate reviews occurred in the initial 13 of 176 (11%) reviews, suggesting a learning curve in interpreting protocol intent. Conclusions. There was widespread acceptance of the concept of centralized pre-radiation quality assurance review and willingness both to submit diagnostic, response, and radiation treatment planning images and to implement recommended changes. We believe this to be the first centralized pre-therapy review and intervention in a U.S. based cooperative trial group. Interventions were frequently required and offered an excellent opportunity for investigator education. There were fewer major protocol violations at FR in cases subjected to PR than in cases not submitted for PR, indicating a major impact on eliminating protocol non-compliance as a variable influencing outcomes in cooperative group trials.

Radiation therapy in clinical stage I and II Hodgkin's disease

1992 ◽  
Vol 28 (11) ◽  
pp. 1841-1846 ◽  
Author(s):  
Mary K Gospodarowicz ◽  
S.B Sutcliffe ◽  
D.E Bergsagel ◽  
T Chua
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Stage I

Long-term follow-up of testicular function following radiation therapy for early-stage Hodgkin's disease.

1989 ◽  
Vol 7 (6) ◽  
pp. 718-724 ◽  
Author(s):  
T J Kinsella ◽  
G Trivette ◽  
J Rowland ◽  
R Sorace ◽  
R Miller ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Cell Injury ◽  
Radiation Treatment ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Semen Analysis ◽  
Dose Range ◽  
Testicular Function

Seventeen male patients with pathological staged I-IIIA1 Hodgkin's disease were followed prospectively for radiation damage to the testes from low-dose scattered irradiation. During conventionally fractionated radiation therapy, the testicular dose ranged from 6 to 70 cGy. Testicular function was measured in a prospective fashion by repeated analyses (every 6 to 12 months) of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. Patients were also followed by serial semen analyses and by a questionnaire on fertility. The follow-up period ranged from 3 to 7 years after completion of radiation therapy. In patients receiving greater than or equal to 20 cGy, there was a dose-dependent increase in serum FSH values following irradiation, with the maximum difference at 6 months compared with pretreatment levels. All patients showed a return to normal FSH values within 12 to 24 months following irradiation. No significant changes in LH and testosterone were observed in this patient group. Eight patients with a normal pretreatment semen analysis provided serial semen samples and two patients showed transient oligospermia with complete recovery by 18 months following treatment. Four patients have fathered normal offspring following radiation therapy. We conclude that low doses (greater than 20 cGy) of scatter irradiation during treatment for Hodgkin's disease can result in transient injury to the seminiferous tubule as manifested by elevations of FSH for 6 to 24 months following treatment. Below 20 cGy, FSH values remained in the normal range. No evidence of Leydig cell injury (using LH and testosterone) was seen in this dose range (up to 70 cGy). Thus, patients with early-stage Hodgkin's disease can be treated with radiation therapy with little to no risk of irreversible testicular injury. Radiation treatment techniques to shield the testes are discussed.

Probability of carcinogenesis due to involved field and involved site radiation therapy techniques for supra- and infradiaphragmatic Hodgkin’s disease

2019 ◽  
Vol 57 ◽  
pp. 100-106 ◽  
Author(s):  
Kalliopi M. Kourinou ◽  
Michalis Mazonakis ◽  
Efrosini Lyraraki ◽  
Helen Α. Papadaki ◽  
John Damilakis
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Involved Field
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