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.

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 for early stage Hodgkin's disease: Australasian patterns of care

1995 ◽  
Vol 31 (2) ◽  
pp. 227-236 ◽  
Author(s):  
Michael Barton ◽  
John Boyages ◽  
Elizabeth Crennan ◽  
Sidney Davis ◽  
Richard J. Fisher ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Patterns Of Care

scholarly journals Involved field radiation therapy for early stage Hodgkin's disease in children.Preliminary results

Cancer ◽  
1976 ◽  
Vol 37 (4) ◽  
pp. 1625-1632 ◽  
Author(s):  
William C. Cham ◽  
Charlotte T. C. Tan ◽  
Alvaro Martinez ◽  
Philip R. Exelby ◽  
Melvin Tefft ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Field Radiation ◽  
Involved Field

Results of a Prospective Trial of Mantle Irradiation Alone for Selected Patients With Early-Stage Hodgkin’s Disease

2001 ◽  
Vol 19 (3) ◽  
pp. 736-741 ◽  
Author(s):  
Kendall H. Backstrand ◽  
Andrea K. Ng ◽  
Ronald W. Takvorian ◽  
Ellen L. Jones ◽  
David C. Fisher ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Prospective Trial ◽  
Stage I ◽  
Mixed Cellularity ◽  
European Organization ◽  
Extended Field

PURPOSE: To determine the efficacy of mantle radiation therapy alone in selected patients with early-stage Hodgkin’s disease. PATIENTS AND METHODS: Between October 1988 and June 2000, 87 selected patients with pathologic stage (PS) IA to IIA or clinical stage (CS) IA Hodgkin’s disease were entered onto a single-arm prospective trial of treatment with mantle irradiation alone. Eighty-three of 87 patients had ≥ 1 year of follow-up after completion of mantle irradiation and were included for analysis in this study. Thirty-seven patients had PS IA, 40 had PS IIA, and six had CS IA disease. Histologic distribution was as follows: nodular sclerosis (n = 64), lymphocyte predominant (n = 15), mixed cellularity (n = 3), and unclassified (n = 1). Median follow-up time was 61 months. RESULTS: The 5-year actuarial rates of freedom from treatment failure (FFTF) and overall survival were 86% and 100%, respectively. Eleven of 83 patients relapsed at a median time of 27 months. Nine of the 11 relapses contained at least a component below the diaphragm. All 11 patients who developed recurrent disease were alive without evidence of Hodgkin’s disease at the time of last follow-up. The 5-year FFTF in the 43 stage I patients was 92% compared with 78% in the 40 stage II patients (P = .04). Significant differences in FFTF were not seen by histology (P = .26) or by European Organization for Research and Treatment of Cancer H-5F eligibility (P = .25). CONCLUSION: Mantle irradiation alone in selected patients with early-stage Hodgkin’s disease is associated with disease control rates comparable to those seen with extended field irradiation. The FFTF is especially favorable among stage I patients.

scholarly journals Radiation therapy in the management of early stage Hodgkin's disease presenting in later life

Cancer ◽  
1991 ◽  
Vol 68 (9) ◽  
pp. 1869-1873 ◽  
Author(s):  
A. L. Zietman ◽  
R. M. Linggood ◽  
A. R. Brookes ◽  
K. Convery ◽  
A. Piro
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Later Life

The eight-drug/radiation therapy program (MOPP/ABDV/RT) for advanced Hodgkin's disease. A follow-up report

Cancer ◽  
1980 ◽  
Vol 46 (2) ◽  
pp. 233-240 ◽  
Author(s):  
David J. Straus ◽  
Jane Myers ◽  
Sharon Passe ◽  
Charles W. Young ◽  
Lourdes Z. Nisce ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Therapy Program ◽  
Advanced Hodgkin’S Disease

Radiation therapy is better than chemotherapy in early-stage Hodgkin's disease? Not so fast.

1992 ◽  
Vol 10 (8) ◽  
pp. 1367-1369 ◽  
Author(s):  
D L Longo ◽  
P L Duffey ◽  
S M Hubbard ◽  
R C Young ◽  
V T DeVita
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Better Than

Radiotherapy with curative intent: an option in selected patients relapsing after chemotherapy for advanced Hodgkin's disease.

1987 ◽  
Vol 5 (4) ◽  
pp. 550-555 ◽  
Author(s):  
M Roach ◽  
D S Kapp ◽  
S A Rosenberg ◽  
R T Hoppe
Keyword(s):  
Radiation Therapy ◽  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Complete Response ◽  
Curative Intent ◽  
Major Toxicity ◽  
Disease Free ◽  
Advanced 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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