Major complications and causes of death in patients treated for Hodgkin's disease.

1987 ◽  
Vol 5 (10) ◽  
pp. 1624-1633 ◽  
Author(s):  
R E van Rijswijk ◽  
J Verbeek ◽  
C Haanen ◽  
A W Dekker ◽  
W A van Daal ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Hodgkin's Disease ◽  
Causes Of Death ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Salvage Chemotherapy ◽  
Histologic Subtype ◽  
Combined Modality ◽  
Increased Risk ◽  
Actuarial Risk

A total of 340 patients with Hodgkin's disease were evaluated for the occurrence of intercurrent fatalities after treatment with radiotherapy, chemotherapy, combined modality therapy, and salvage chemotherapy. Mean follow-up time was 76.6 months. Causes of death were compared with the expected risk, calculated from mortality statistics of the Netherlands' population. Sixty-seven patients died of progressive Hodgkin's disease, whereas 37 patients died of causes unrelated to advanced disease. Patients showed an increased risk of dying of leukemia and solid tumors (P less than .001), whereas the risk of dying of cardiovascular complications was not increased. The 10-year actuarial risk of dying of leukemia varied between 0% for patients treated with radiotherapy only and 5.7% for those needing salvage chemotherapy. The 10-year risk of dying of solid tumors was 0% for patients treated with chemotherapy and 6.5% for those receiving radiotherapy. Treatment-related fatalities were highest after combined modality therapy (P less than .025); the corresponding 10-year risk was 6.1%. Compared with younger ones, patients greater than or equal to 40 years had an increased risk of dying of causes unrelated to progressive Hodgkin's diseases. The actuarial risk of developing intercurrent fatalities at 10 years was 4.9% in patients less than 40 years, and 34.7% in those greater than or equal to 40 years (P less than .001). Compared with population based statistics, patients successfully treated for Hodgkin's disease still showed an increased risk of dying (P less than .001). Treatment modality, stage, and histologic subtype were not predictors of intercurrent death.

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.

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

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.

Reduction of fatal complications from combined modality therapy in Hodgkin's disease.

1985 ◽  
Vol 3 (4) ◽  
pp. 501-505 ◽  
Author(s):  
P M Mauch ◽  
G P Canellos ◽  
D S Rosenthal ◽  
S Hellman
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Low Risk ◽  
Acute Nonlymphocytic Leukemia ◽  
Maintenance Chemotherapy ◽  
Fatal Complication ◽  
Actuarial Risk ◽  
Fatal Complications

A total of 464 pathologically staged IA through IIIB Hodgkin's disease patients were evaluated for the risk of developing acute nonlymphocytic leukemia, non-Hodgkin's lymphoma, or a fatal infection after treatment with radiation therapy (RT) alone, initial combined radiation therapy and chemotherapy (CMT), or RT with MOPP administered at relapse. Patients received a standard six cycles of MOPP, and additional maintenance chemotherapy was not administered. Patients receiving total nodal irradiation (TNI) and MOPP chemotherapy have an 11.9% actuarial risk of developing a fatal complication at ten years, as compared to a 0.8% risk for lesser field irradiation and MOPP (P = .005). The risk with RT alone is 0.6%. Patients 40 years of age or older have a greater risk for complications. These data report a low risk for fatal complication with CMT when less than TNI is administered and when maintenance chemotherapy is not used.

Second solid malignancies after combined modality therapy for Hodgkin's disease.

1995 ◽  
Vol 13 (8) ◽  
pp. 2016-2022 ◽  
Author(s):  
R Doria ◽  
T Holford ◽  
L R Farber ◽  
L R Prosnitz ◽  
D L Cooper
Keyword(s):  
Solid Tumors ◽  
Hodgkin's Disease ◽  
Recurrent Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Disease Group ◽  
Solid Malignancies ◽  
Group A ◽  
The Difference ◽  
Group B

PURPOSE To determine the actuarial incidence (AI) and relative risk (RR) of second solid malignancies (SSM; solid tumors and non-Hodgkin's lymphoma) in patients with Hodgkin's disease who were treated with chemotherapy and adjuvant, low-dose radiation (combined modality therapy; CMT). PATIENTS AND METHODS From 1969 to 1983, 102 patients with previously untreated advanced Hodgkin's disease (group A) and 81 patients with recurrent disease after radiation (group B) were treated with CMT. Patients were observed for the development of solid tumors (ST) and non-Hodgkin's lymphoma (NHL), and the AI and RR were calculated. RESULTS Nearly half of the patients entering remission were observed for greater than 15 years. At 20 years, the AI for SSM was 12% in group A versus 41% in group B (P = .009). The overall RR for developing a ST in group A was 1.88 (not significant) versus 8.84 in group B (95% confidence interval, 5.3 to 15.4). The difference in the RR between groups A and B was significant (P < .001). The RR for developing NHL was significantly increased in both groups, but the difference between groups was not significant. CONCLUSION Previously untreated patients with advanced disease who were treated with CMT (group A) had a modest but not significant increase in the RR of ST; however, patients treated with CMT for recurrent disease (group B) had a highly significant increase in the RR of ST. Possible explanations for the increase in ST in group B include more cumulative radiation or a greater carcinogenic effect of chemotherapy in previously irradiated patients, but it also is possible that the increase is due to a longer follow-up time.

The significance of the residual mediastinal mass in treated Hodgkin's disease.

1985 ◽  
Vol 3 (5) ◽  
pp. 637-640 ◽  
Author(s):  
M Jochelson ◽  
P Mauch ◽  
J Balikian ◽  
D Rosenthal ◽  
G Canellos
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Increased Risk ◽  
Additional Chemotherapy ◽  
Long Term Follow Up ◽  
Mediastinal Widening ◽  
Mediastinal Adenopathy ◽  
One Year

The chest roentgenograms of 65 patients treated for Hodgkin's disease with mediastinal adenopathy were analyzed retrospectively to determine the incidence and significance of residual mediastinal abnormality after treatment. All patients were treated with radiation therapy, and 36 patients received additional chemotherapy. On completion of treatment, 57 (88%) of the 65 patients had some residual mediastinal abnormality. These were either minimal changes in the mediastinal shadow in 30 patients or a widening greater than 6 cm in 27 patients. In the latter group, 11 (40%) of 27 patients continued to have residual mediastinal widening one year after completion of therapy. These patients did not have a higher incidence of recurrence. Long-term follow-up (median, 48 months) revealed continued abnormalities in 24 (40%) of the original 57 patients. Mediastinal abnormalities are common at the end of radiation or combined modality therapy for Hodgkin's disease and do not by themselves indicate persistent active disease or an increased risk for relapse. We strongly recommend that additional chemotherapy or higher radiation doses beyond the initially planned course not be used for residual mediastinal widening.

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