Stanford-Kaiser Permanente G1 study for clinical stage I to IIA Hodgkin's disease: subtotal lymphoid irradiation versus vinblastine, methotrexate, and bleomycin chemotherapy and regional irradiation.

1997 ◽  
Vol 15 (5) ◽  
pp. 1736-1744 ◽  
Author(s):  
S J Horning ◽  
R T Hoppe ◽  
J Mason ◽  
B W Brown ◽  
S L Hancock ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Kaiser Permanente ◽  
Number Of Patients ◽  
Ann Arbor ◽  
Extended Field ◽  
Involved Field

PURPOSE We have demonstrated that a relatively mild chemotherapy regimen, vinblastine, methotrexate, and bleomycin (VBM), and involved-field radiotherapy (IFRT) could substitute for extended-field radiotherapy in patients with favorable Hodgkin's disease (HD) who have been laparotomy-staged. The purpose of this study is to determine if VBM and regional radiotherapy can substitute for extended-field radiotherapy in favorable clinical stage (CS) I and II HD. PATIENTS AND METHODS Seventy-eight patients with favorable CS I to II HD were randomly assigned to subtotal lymphoid irradiation (STLI) or VBM chemotherapy and regional radiotherapy. Randomization was stratified on the basis of age, sex, number of Ann Arbor sites, histology, and institution. Patients were evaluated for freedom from progressive HD, survival, and toxicity. Results were compared with the predecessor trial in pathologically staged patients. RESULTS With a median follow-up period of 4 years, the rate of freedom from progressive HD was 92% (95% confidence interval [CI], 88% to 96%) for patients treated with STLI and 87% (95% CI, 81% to 93%) for patients treated with VBM and regional radiotherapy. Six of seven patients who relapsed are alive and in remission following successful second-line therapy. CONCLUSION Given the caveat of a small number of patients, the results of extended-field radiotherapy and VBM and regional radiotherapy are comparable with a median follow-up period of 4 years. VBM serves as a paradigm to reduce late effects in favorable early-stage HD. We do not advocate its routine use in clinical practice, but instead encourage participation in clinical trials with the objective of maintaining efficacy while reducing toxicity in CS I and II HD.

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.

Efficacy and toxicity of vinblastine, bleomycin, and methotrexate with involved-field radiotherapy in clinical stage IA and IIA Hodgkin's disease: a British National Lymphoma Investigation pilot study.

1994 ◽  
Vol 12 (2) ◽  
pp. 288-296 ◽  
Author(s):  
N P Bates ◽  
M V Williams ◽  
E M Bessell ◽  
G Vaughan Hudson ◽  
B Vaughan Hudson
Keyword(s):  
Pilot Study ◽  
Complete Remission ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Clinical Stage Ia ◽  
Stage Ia ◽  
Involved Field ◽  
Involved Field Radiotherapy

PURPOSE To assess the efficacy and toxicity of vinblastine, bleomycin, and methotrexate (VBM) chemotherapy with involved-field radiotherapy in clinical stage IA and IIA Hodgkin's disease. PATIENTS AND METHODS Thirty eligible patients with clinical stage IA or IIA Hodgkin's disease, at intermediate risk of relapse, were enrolled into a prospective multicenter pilot study. They received two cycles of VBM chemotherapy, followed by involved-field radiotherapy and then four further cycles of VBM. The median follow-up duration from the start of treatment is 30 months. RESULTS All 26 patients with assessable disease showed an objective response after two cycles of VBM (nine complete responses, 17 partial responses). By the completion of treatment, 27 patients were in complete remission; two had stable residual masses, which have not progressed at 26 and 34 months of follow-up; and one patient who died of treatment-related sepsis was in complete remission at that time. Two relapses have occurred, 19 and 28 months after starting VBM. Cough and dyspnea developed in 14 of 30 patients, and were associated with impairment of pulmonary function tests. Three episodes of neutropenic sepsis were recorded. CONCLUSION VBM with involved-field radiotherapy is an effective treatment for early Hodgkin's disease. However, the associated toxicity, both pulmonary and hematologic, is severe, making the regimen unsuitable for routine use.

Effect of ABVD chemotherapy with and without mantle or mediastinal irradiation on pulmonary function and symptoms in early-stage Hodgkin's disease.

1996 ◽  
Vol 14 (4) ◽  
pp. 1297-1305 ◽  
Author(s):  
A Hirsch ◽  
N Vander Els ◽  
D J Straus ◽  
E G Gomez ◽  
D Leung ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Pulmonary Function Tests ◽  
Cancer Center ◽  
Mediastinal Irradiation ◽  
Number Of Patients ◽  
Abvd Chemotherapy

PURPOSE To evaluate the effect of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy alone and of ABVD with mantle or mediastinal irradiation (RT) on the pulmonary function of patients with early-stage Hodgkin's disease. PATIENTS AND METHODS Between 1989 and 1993, 60 patients with clinical stage I to IIIA HD enrolled onto randomized trials at Memorial Sloan-Kettering Cancer Center (MSKCC) underwent prospective evaluation of pulmonary function. All patients received six cycles of ABVD, and 30 patients received mantle or mediastinal RT. Pulmonary function tests (PFTs) and symptom evaluation were conducted before, during, and after completion of chemotherapy and RT, and at various intervals thereafter. The median follow-up time was 30 months. RESULTS During chemotherapy, symptoms of cough and dyspnea on exertion developed in 32 of 60 patients (53%) and declines in pulmonary function occurred in 22 of 60 patients (37%). Discontinuation of bleomycin was necessary in 14 of 60 patients (23%). Following chemotherapy, there was a significant decline in median forced vital capacity (FVC) and diffusing capacity of carbon monoxide (DLCO). In patients who received mantle or mediastinal RT, there was a further decline in FVC following radiation therapy. At the most recent follow-up evaluation, five of 29 patients (18%) who received ABVD alone and nine of 30 (30%) who received ABVD and RT reported persistent mild pulmonary symptoms (P = .36), which did not significantly affect normal daily activity. CONCLUSION ABVD chemotherapy induced acute pulmonary toxicity that required bleomycin dose modification in a substantial number of patients. The addition of RT resulted in a further decrease in FVC; however, this did not significantly affect the functional status of patients.

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

Histology as a Prognostic Factor in 100 Cases of Hodgkin's Disease

1966 ◽  
Vol 52 (6) ◽  
pp. 451-464 ◽  
Author(s):  
Sergio Di Pietro ◽  
Federico Pizzetti
Keyword(s):  
Prognostic Factor ◽  
National Cancer Institute ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
The Third ◽  
Nodular Sclerosis ◽  
At Iii ◽  
Mediastinal Involvement

The paper deals with 100 cases of Hodgkin's disease, treated at the National Cancer Institute of Milan from 1949 to 1958, all submitted to clinical follow-up until the end of November 1966 or death. Histologically, the 100 cases were grouped as follows: 14 paragranulomas, 15 nodular scleroses, 49 polymorphous granulomas and 22 Hodgkin's sarcomas. Paragranulomas showed the best average median and 10-year survivals, nodular sclerosis the best 5-year survivals; Hodgkin's sarcomas showed the worst clinical evolution, without 10-year survivals. The behaviour of the disease was found to be more unfavourable in the third and fourth decades of life, more favourable in the fifth decade. In men the evolution was slower, after an initial unfavourable course; no 10-year survival was observed in women. Nodular sclerosis prevailed in early diagnosed patients, paragranuloma and Hodgkin's sarcoma in late diagnosed cases. Eighty-eight of the 100 patients were at III and IV clinical stage at admission, only 12 at I or II stage. Nearly all cases of nodular sclerosis concerned patients at the III stage, with mediastinal involvement; Hodgkin's sarcoma was more frequent in patients at the IV stage. Five-year survival at the IV stage was observed only in patients with paragranuloma or nodular sclerosis; these two histological types prevailed also in patients without general symptoms. Polymorphous granuloma and Hodgkin's sarcoma were more frequent in patients with general symptoms.

Treatment of 49 Unrandomized Patients with Advanced Hodgkin's Disease

1983 ◽  
Vol 69 (5) ◽  
pp. 463-467
Author(s):  
Teodoro Chisesi ◽  
Orlando Ricciardi ◽  
Sandra Dal Fior ◽  
Francesco Cappellari ◽  
Franco Pozza ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Adjuvant Radiotherapy ◽  
Hodgkin’S Disease ◽  
Treatment Modalities ◽  
Significant Difference ◽  
Involved Field ◽  
Involved Field Radiotherapy ◽  
Abvd Chemotherapy ◽  
Advanced Hodgkin’S Disease

Forty-nine patients with previously untreated advanced Hodgkin's disease were treated in our Institution between 1973 and 1981. Treatment modalities of these patients were reviewed, and they were divided into 3 groups according to the treatment employed: 13 patients received MOPP only, 22 patients received MOPP plus involved field radiotherapy, and 14 received alternating MOPP/ABVD chemotherapy. The response rates for the 3 groups were respectively 38.5%, 63.6% and 78.6%. A longer follow-up is needed to assess a significant difference in survival curves. The advantages of adjuvant radiotherapy and alternating non-cross-resistant drugs in advanced Hodgkin's disease are discussed.

Clinical stages I and II Hodgkin's disease: a specifically tailored therapy according to prognostic factors.

1988 ◽  
Vol 6 (2) ◽  
pp. 239-252 ◽  
Author(s):  
P Carde ◽  
J M Burgers ◽  
M Henry-Amar ◽  
M Hayat ◽  
W Sizoo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
European Organization ◽  
Free Survival ◽  
Negative Laparotomy ◽  
Extended Field ◽  
The Difference ◽  
Better Than

The H5 program in clinical stage (CS) I to II supradiaphragmatic Hodgkin's disease (HD) was tailored to prognostic factors identified in former European Organization for the Research and Treatment of Cancer (EORTC) studies. Among the 494 adult patients included in the study, the 237 patients belonging to the favorable group (H5F) underwent a staging laparotomy (Sx) in order to select the patients who could be treated with limited radiotherapy (RT) only. Thus, 198 patients (84%) with negative laparotomy were treated with RT alone and randomized to either mantle irradiation (M) or extended field mantle plus para-aortic (M + PA) irradiation. Complete remission (CR) was achieved in 99% of the patients. There was no difference in the 6-year relapse-free survival (RFS) rate (74% and 72%, respectively) or survival rate (96% and 89%). Therefore, Sx helped to define those patients who could be treated with M alone in contrast to those who required more aggressive therapy. The 39 patients with positive laparotomy were treated as the unfavorable group (H5U) from onset and randomized to either total/subtotal nodal irradiation (TNI/STNI) or a sandwiched mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) X 3, M irradiation, MOPP X 3 protocol (3M). Although the RFS rate was higher in the 3M arm (100% v 53%; P = .002), the 6-year survival was not significantly different between the two arms (overall, 92%). In the 257 patients with initial unfavorable disease, the Sx was avoided. They were randomized to either TNI/STNI or 3M. In complete responders (96%), the 6-year RFS was 91% in the 3M arm and 77% in the TNI/STNI arm (P = .02). The pattern of failure differed in the two arms: the inverted Y and spleen irradiation controlled occult infradiaphragmatic disease better than MOPP; conversely, less patients begun on MOPP recurred in the involved mantle areas. The difference in 6-year actuarial total survival (TS) (89% and 82%; P = .05 in favor of the 3M arm) was not retrieved after exclusion of the unrelated deaths from the analysis. The two arms produced similar TS in patients under 40 years of age. TNI retains interest, especially in young men wishing to preserve fertility. The overall result shows that when treatment is tailored to initial prognostic factors, excellent results can be obtained in all patient subgroups at minimal morbidity and toxic cost.

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