Stage IIB Hodgkin's disease: the Stanford experience.

1986 ◽  
Vol 4 (4) ◽  
pp. 472-479 ◽  
Author(s):  
M J Crnkovich ◽  
R T Hoppe ◽  
S A Rosenberg
Keyword(s):  
Relapse Rate ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Survival Rates ◽  
Actuarial Survival ◽  
Combined Modality ◽  
Significant Difference ◽  
Ann Arbor ◽  
The Impact

Between 1968 and 1982, 126 patients with pathologic stage (PS) IIB Hodgkin's disease were treated at Stanford University with either irradiation alone or irradiation combined with chemotherapy. Actuarial survival and freedom from relapse rates at 10 years for the overall group were 81% and 74% respectively, with no statistically significant difference between the treatment approaches. The impact of the severity and number of constitutional (B) symptoms, as defined by the Ann Arbor Conference, was analyzed. Patients who presented with all three B symptoms had significantly poorer survival and freedom from relapse compared with those patients with only one or two B symptoms (for survival differences, P = .005 and .007; for freedom from relapse differences, P = .002 and .04). Male sex was the only other prognostic factor that correlated with a poor outcome. At 10 years, the survival rate was 66% for males v 84% for females (P = .01), and the freedom from relapse rate was 75% for males v 89% for females (P = .02). The presence of extralymphatic sites of involvement, age greater than 40, or involvement of greater than three lymphoid sites had no significant adverse effect on either freedom from relapse or survival. Patients with large mediastinal masses treated with irradiation alone had a 10-year freedom from relapse rate of 54% v 81% for those treated with combined-modality therapy (P = .15), but there was no significant difference in survival rates (85% for irradiation alone v 71% for combined modality therapy). Treatment recommendations for stage IIB Hodgkin's disease are discussed.

Prognostic Factors for Children With Hodgkin’s Disease Treated With Combined-Modality Therapy

2003 ◽  
Vol 21 (10) ◽  
pp. 2026-2033 ◽  
Author(s):  
Ron S. Smith ◽  
Qing Chen ◽  
Melissa M. Hudson ◽  
Michael P. Link ◽  
Larry Kun ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Prognostic Index ◽  
Combined Modality ◽  
Mediastinal Disease ◽  
Significant Difference

Purpose: Evaluation of pretreatment factors to identify children at high risk for relapse after combined-modality therapy for Hodgkin’s disease. Patients and Methods: From 1990 to 2000, 328 pediatric patients with clinical stage I to IV Hodgkin’s disease were treated with chemotherapy and low-dose involved-field radiotherapy on prospective, collaborative, risk-adapted protocols at three institutions. Pretreatment factors were analyzed by univariate and multivariate analysis for prognostic significance for 5-year disease-free survival (DFS) and overall survival (OS). Results: With a median follow-up of 59 months (range, 8 to 125 months), the 5-year DFS and OS for all patients were 83% and 93%, respectively. Several factors were associated with inferior DFS and OS by univariate analysis. By multivariate analysis, male sex; stage IIB, IIIB, or IV disease; bulky mediastinal disease; WBC more than 13.5 × 103/mm3; and hemoglobin less than 11.0 g/dL were significant for inferior DFS. A prognostic index was developed incorporating the five significant factors from the multivariate analysis, assigning each a score of 1. The 5-year DFS and OS for children with a prognostic score of 0 to 1 were 94% and 99%; score 2, 85% and 96%; score 3, 71% and 92%; and score 4 or 5, 49% and 72%, respectively. There was a significant difference in DFS among each of these groups, with significantly worse OS in those with a score of 4 to 5. Conclusion: A prognostic index that was based on five pretreatment factors correlated with inferior DFS by multivariate analysis stratified patients by outcome; this may be useful in assigning children with Hodgkin’s disease to risk-adapted therapy.

scholarly journals The management of stage I--II Hodgkin's disease with irradiation alone or combined modality therapy: the Stanford experience

Blood ◽  
1982 ◽  
Vol 59 (3) ◽  
pp. 455-465 ◽  
Author(s):  
RT Hoppe ◽  
CN Coleman ◽  
RS Cox ◽  
SA Rosenberg ◽  
HS Kaplan
Keyword(s):  
Hodgkin's Disease ◽  
Mediastinal Mass ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Stage I ◽  
Actuarial Survival ◽  
Histologic Subtype ◽  
Combined Modality ◽  
Systemic Symptoms

Abstract At Stanford University, between 1968 and 1978, 230 patients with pathologic stage I--II Hodgkin's disease were treated on prospective clinical trials with either irradiation alone or irradiation followed by 6 cycles of adjuvant combination chemotherapy. The actuarial survival at 10 yr was 84% for patients in either treatment group. Freedom from relapse at 10 yr was 77% among patients treated with irradiation alone and 84% after treatment with combined modality therapy [p(Gehan) = 0.09]. Freedom from second relapse at 10 yr was 89% and 94%, respectively [p(Gehan) = 0.56]. Several prognostic factors were evaluated in order to identify patients at high risk for relapse or with poor ultimate survival after initial treatment with irradiation alone. Systemic symptoms, histologic subtype, age, and limited extranodal involvement (E-lesions) did not affect the prognosis of patients and failed to identify patients whose survival could be improved by the routine use of combined modality therapy. Patients with large mediastinal masses (mediastinal mass ratio greater than or equal to 1/3) had a significantly poorer freedom from relapse when treated with irradiation alone than when treated initially with combined modality therapy [45% versus 81% at 10 yr, p(Gehan) = 0.03). The 10-yr survival of these patients, however, was not significantly different (84% versus 74%). The implications of these observations on the management of patient with early stage Hodgkin's disease are discussed.

Combined modality treatment with low-dose radiation and MOPP chemotherapy for children with Hodgkin's disease.

1987 ◽  
Vol 5 (5) ◽  
pp. 742-749 ◽  
Author(s):  
S S Donaldson ◽  
M P Link
Keyword(s):  
Hodgkin's Disease ◽  
Low Dose ◽  
Bone Growth ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Combined Modality Treatment ◽  
Actuarial Survival ◽  
Combined Modality

High doses of radiation administered to children with Hodgkin's disease may be associated with long-term alterations in soft tissue and bone growth. In an attempt to minimize this complication, we initiated a protocol using low doses of radiation in conjunction with six cycles of MOPP (nitrogen mustard, vincristine, procarbazine, prednisone) chemotherapy in newly diagnosed, pathologically staged children with Hodgkin's disease. Of 55 children treated in this fashion, the actuarial survival and freedom from relapse rates are 89% and 90%, respectively, with median follow-up of 7 1/2 years and maximum follow-up of 15 1/2 years. The local control rate is 97%. The previously encountered growth alteration did not occur when lower doses of radiation were used. However, three children developed acute leukemia. This study demonstrates that the vast majority of children with Hodgkin's disease can be cured with combined modality therapy. This experience provides long-term follow-up and thus serves as the basis for new ongoing protocols using low-dose involved field radiation with new drug combinations.

scholarly journals The management of stage I--II Hodgkin's disease with irradiation alone or combined modality therapy: the Stanford experience

Blood ◽  
1982 ◽  
Vol 59 (3) ◽  
pp. 455-465 ◽  
Author(s):  
RT Hoppe ◽  
CN Coleman ◽  
RS Cox ◽  
SA Rosenberg ◽  
HS Kaplan
Keyword(s):  
Hodgkin's Disease ◽  
Mediastinal Mass ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Stage I ◽  
Actuarial Survival ◽  
Histologic Subtype ◽  
Combined Modality ◽  
Systemic Symptoms

At Stanford University, between 1968 and 1978, 230 patients with pathologic stage I--II Hodgkin's disease were treated on prospective clinical trials with either irradiation alone or irradiation followed by 6 cycles of adjuvant combination chemotherapy. The actuarial survival at 10 yr was 84% for patients in either treatment group. Freedom from relapse at 10 yr was 77% among patients treated with irradiation alone and 84% after treatment with combined modality therapy [p(Gehan) = 0.09]. Freedom from second relapse at 10 yr was 89% and 94%, respectively [p(Gehan) = 0.56]. Several prognostic factors were evaluated in order to identify patients at high risk for relapse or with poor ultimate survival after initial treatment with irradiation alone. Systemic symptoms, histologic subtype, age, and limited extranodal involvement (E-lesions) did not affect the prognosis of patients and failed to identify patients whose survival could be improved by the routine use of combined modality therapy. Patients with large mediastinal masses (mediastinal mass ratio greater than or equal to 1/3) had a significantly poorer freedom from relapse when treated with irradiation alone than when treated initially with combined modality therapy [45% versus 81% at 10 yr, p(Gehan) = 0.03). The 10-yr survival of these patients, however, was not significantly different (84% versus 74%). The implications of these observations on the management of patient with early stage Hodgkin's disease are discussed.

2161 Reduction of adverse effects of combined modality therapy with subtotal nodal irradiation in stage IIIA Hodgkin's disease

1996 ◽  
Vol 36 (1) ◽  
pp. 356
Author(s):  
Farley E. Yang ◽  
Jaishanker Nautiyal ◽  
Claire Powers ◽  
Dennis Hallahan ◽  
Srinivasan Vijayakumar ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Stage Iiia ◽  
Combined Modality

Treatment of advanced Hodgkin's disease with chemotherapy--comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group.

1997 ◽  
Vol 15 (4) ◽  
pp. 1638-1645 ◽  
Author(s):  
J M Connors ◽  
P Klimo ◽  
G Adams ◽  
B F Burns ◽  
I Cooper ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Survival Rates ◽  
Prospective Trial ◽  
Treatment Center ◽  
Wide Field ◽  
Free Survival ◽  
Significant Difference ◽  
The Difference ◽  
Advanced Hodgkin’S Disease

PURPOSE This randomized, prospective trial compares outcomes for patients with advanced Hodgkin's disease treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, and vinblastine (ABV) hybrid regimen or alternating MOPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). METHODS Three hundred one patients with advanced Hodgkin's disease were randomized to receive MOPP/ ABV hybrid regimen or alternating MOPP/ABVD after stratification for prior treatment, B symptoms, and treatment center. Eligible patients were either previously untreated and found to have stage IIIB, IVA, or IVB disease or previously treated with wide-field irradiation. Responding patients received a minimum of eight cycles of chemotherapy. Those with residual disease in a localized region received irradiation between the sixth and seventh cycle of treatment. RESULTS Response rates to the two regimens were similar. Five-year overall survival rates were 81% and 83% for MOPP/ABV hybrid and alternating MOPP/ ABVD, respectively (P = .74; 95% confidence interval [CI] for the difference, -11% to 7%). Five-year failure-free survivals were 71% and 67% for MOPP/ABV hybrid and alternating MOPP/ABVD, respectively (P = .87; 95% CI for the difference, -9% to 17%). Significantly more episodes of febrile neutropenia and stomatitis were observed with the MOPP/ABV hybrid regimen; there was no significant difference in fatal toxicity. Patients with predefined, high-quality partial responses (PR-1s) had results similar to those with complete responses (CRs). Planned subset analysis showed no significant difference in outcome between the two arms of the trial for patients with newly diagnosed disease (5-year failure-free survival rates were 70% for MOPP/ABV hybrid and 59% for alternating MOPP/ABVD; P = .180), but superiority of alternating MOPP/ABVD for patients with prior irradiation (5-year failure-free survival 94% v 73%; P = .017). CONCLUSION MOPP/ABV hybrid and alternating MOPP/ABVD regimens are equally effective for patients with advanced Hodgkin's disease.

Treatment of pediatric Hodgkin's disease with chemotherapy alone or combined modality therapy

1999 ◽  
Vol 7 (6) ◽  
pp. 365-373 ◽  
Author(s):  
Samar Muwakkit ◽  
Fady Geara ◽  
Bassem Nabbout ◽  
Roula A. Farah ◽  
Nina S. Shabb ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Combined Modality
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