Randomized study of intensive MOPP-ABVD with or without low-dose total-nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin's disease in pediatric patients: a Pediatric Oncology Group study.

1997 ◽  
Vol 15 (8) ◽  
pp. 2769-2779 ◽  
Author(s):  
M A Weiner ◽  
B Leventhal ◽  
M L Brecher ◽  
R B Marcus ◽  
A Cantor ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Low Dose ◽  
Pediatric Patients ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Randomized Study ◽  
Advanced Stage ◽  
Protocol Violation ◽  
Pediatric Oncology Group ◽  
To Receive

PURPOSE To determine whether the addition of low-dose total-nodal irradiation (TNI) in pediatric patients with advanced-stage Hodgkin's disease who have received eight cycles of alternating mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) will improve the event-free survival (EFS) and overall survival (OS) when compared with patients who have received chemotherapy only. PATIENTS AND METHODS At diagnosis, 183 children and adolescents with stages IIB, IIIA2, IIIB, and IV Hodgkin's disease were randomized to receive eight cycles of alternating MOPP-ABVD with or without low-dose TNI. RESULTS Of 183 patients, four were rendered ineligible before treatment was initiated. One hundred sixty-one of 179 patients (90%) were in complete remission (CR) at the completion of eight cycles of alternating MOPP-ABVD; 81 were in the chemotherapy-only group and proceeded to observation off therapy, whereas 80 of 161 were to receive combined modality therapy (CMT). Nine of 80 patients randomized at the time of diagnosis to receive CMT did not receive radiation (RT) because of a protocol violation, but were monitored for EFS and OS and included in all analyses. The estimated EFS and OS rates at 5 years for the 179 eligible patients are 79% and 92%, respectively. The actuarial EFS at 5 years was 80% for patients who received CMT and 79% for patients who received MOPP-ABVD only. The OS for the former group is estimated to be 87% and for the latter patients 96%. Age < or = 13 years of age at diagnosis and the attainment of a clinical CR after three cycles of chemotherapy were associated with a statistically significant improved EFS. CONCLUSION Our results indicate that after the delivery of eight cycles of MOPP-ABVD, the addition of low-dose RT does not improve the estimated EFS or OS in pediatric patients with advanced-stage Hodgkin's disease.

Treatment of Unfavorable Childhood Hodgkin’s Disease With VEPA and Low-Dose, Involved-Field Radiation

2002 ◽  
Vol 20 (14) ◽  
pp. 3088-3094 ◽  
Author(s):  
Alison M. Friedmann ◽  
Melissa M. Hudson ◽  
Howard J. Weinstein ◽  
Sarah S. Donaldson ◽  
Larry Kun ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Low Dose ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Stage I ◽  
Stage Iii ◽  
Advanced Stage ◽  
Combined Modality ◽  
Field Radiation ◽  
Involved Field

PURPOSE: Between January 1990 and April 1993, 56 pediatric patients with Hodgkin’s disease were treated on a single-arm trial at three institutions with a regimen designed to maintain high cure rates while minimizing the potential late effects of treatment, such as infertility, second malignant neoplasms, and cardiopulmonary injury. PATIENTS AND METHODS: The regimen used combined-modality therapy with six cycles of vinblastine, etoposide, prednisone, and doxorubicin (VEPA) chemotherapy and low-dose, involved-field radiation. Unfavorable features comprised bulky presentations of localized (stage I or II) disease or advanced (stage III or IV) Hodgkin’s disease. RESULTS: Of 56 patients enrolled, 26 (46%) had unfavorable presentations of stage I/II disease and 30 (54%) had advanced (stage III/IV) disease. Seventy-nine percent of the patients are alive without disease at a median follow-up time of 8.9 years from diagnosis. Nineteen patients had events at a median of 1.5 years (range, 0.4 to 7.9 years) from diagnosis; 17 patients relapsed, one died of cardiomyopathy, and one died of accidental injuries. Survival and event-free survival (EFS) estimates at 5 years for the entire cohort were 81.9% (SE, 5.2%) and 67.8% (SE, 6.3%), respectively. Five-year EFS by stage was 100% for stage I, 79.2% (SE, 8.3%) for stage II, 70% (SE, 14.5%) for stage III, and 49.5% (SE, 11.3%) for stage IV patients. CONCLUSION: Combined-modality therapy with VEPA chemotherapy and low-dose, involved-field radiation is adequate for disease control of early-stage patients with unfavorable features, but it is inferior to other standard regimens for advanced-stage patients.

Intensive chemotherapy and low-dose radiotherapy for the treatment of advanced-stage Hodgkin's disease in pediatric patients: a Pediatric Oncology Group study.

1991 ◽  
Vol 9 (9) ◽  
pp. 1591-1598 ◽  
Author(s):  
M A Weiner ◽  
B G Leventhal ◽  
R Marcus ◽  
M Brecher ◽  
J Ternberg ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Hodgkin's Disease ◽  
Low Dose ◽  
Residual Disease ◽  
Hodgkin’S Disease ◽  
Acute Myelocytic Leukemia ◽  
Advanced Stage ◽  
Oncology Group ◽  
Low Dose Radiotherapy ◽  
Pediatric Oncology Group

Sixty-two patients with advanced-stage Hodgkin's disease and a median age of 12 years (range, 3 to 22 years) were treated with four cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) alternating with four cycles of doxorubicin, vinblastine, bleomycin, and dacarbazine (ABVD) followed by low-dose radiotherapy (RT). We determined the feasibility, immediate safety, and rapidity of response of patients to this regimen, as well as the relationship between prognostic factors and the rate of complete remission (CR), event-free survival (EFS), and overall survival. Therapy was well tolerated, and the major toxicity was hematopoietic. At the end of chemotherapy, 54 of 62 patients (87%) were in CR by clinical restaging, with a biopsy of residual disease where necessary. The actuarial 3-year EFS is 77% (SE, 11%), with a median follow-up of 35 months, and the survival is 91% (SE, 7%). With respect to EFS, female patients and those with stage II or III disease fared statistically better than males and patients with stage IV disease, respectively. Six patients have died: three of progressive Hodgkin's disease, one of secondary acute myelocytic leukemia (AML), one of secondary non-Hodgkin's lymphoma (NHL), and one of overwhelming bacterial sepsis. The Pediatric Oncology Group (POG) is currently engaged in a randomized study of these eight cycles of chemotherapy with and without RT to assess the role of RT in achieving comparable results.

Successful treatment with minimal chemotherapy followed by low-dose involved field radiotherapy in children with Hodgkin's disease: A 20-year experience in a single institution in Greece

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10052-10052
Author(s):  
A. G. Pourtsidis ◽  
D. Doganis ◽  
M. Baka ◽  
D. Bouhoutsou ◽  
M. Varvoutsi ◽  
...  
Keyword(s):  
Complete Remission ◽  
Hodgkin's Disease ◽  
Low Dose ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Stage Iv ◽  
High Dose ◽  
Main Question ◽  
Radio Therapy

10052 Background: The vast majority of children with Hodgkin's disease (HD) nowadays have an excellent chance of definite cure. The high curative rates as well as the prevention of late effects have to be among aims when managing children with HD. The purpose of our retrospective study was to report the outcome and prognostic factors of patients (pts) less than 15 years of age with HD treated with chemotherapy (CT) followed by low dose radiation from 1987 to 2006. Methods: We studied 58 children analyzing the following data: age, sex, stage, histology, therapy correlating these with the outcome of pts. Among 35 boys and 23 girls, age at diagnosis 4.5 - 15 years (median 12), all aged 7 years or less were boys (8/58). Nodurar sclerosis was the predominant histology subtype (69%) and 45% had advanced disease (stages III or IV). According the study period pts with early stage received 4 cycles of ABVD or VBVP and those with advanced stage disease alternating 3 cycles of MOPP/ABVD or 2 of MOPP/ABVP for stage III and alternating 3 cycles of MOPP/ABVD or 2 OPPA plus 4 COPP for stage IV. All pts had a good response (more than a 70% reduction) after initial CT and received 20 Gy of RT to initially involved fields. Results: Complete remission (CR) was achieved in all patients. Chemo- and radio-therapy were well tolerated. Fifty-three pts (DFS: 91.4%) live in their first complete remission. In 5 pts (8.6 %) relapse occurred, 20 -65 months from dx (median 25 mo). All received salvage treatment in combination with high dose CT and autologous stem-cell transplantation (SCT). Of the 5 relapsed all live 21 - 207 months (median 75 mo) from the dx of relapse and 41 - 232 mo (median 99) from the dx of disease. Second (thyroid cancer) plus third malignancy in one (osteosarcoma) was detected in 3 pts and all are alive. Finally for our group the overall survival is 100% and all children are alive 25 - 264 mo from dx (median 145 mo) and the event free survival is 86.2% (50/58). No factors related to the outcome were detected. Conclusions: In conclusion combined-modality therapy remains the standard of care for children with HD. However, there may be a significant number who can be cured with chemotherapy alone. At this moment the main question is: who can be cured without RT? No significant financial relationships to disclose.

Randomized Comparison of Low-Dose Involved-Field Radiotherapy and No Radiotherapy for Children With Hodgkin’s Disease Who Achieve a Complete Response to Chemotherapy

2002 ◽  
Vol 20 (18) ◽  
pp. 3765-3771 ◽  
Author(s):  
James B. Nachman ◽  
Richard Sposto ◽  
Philip Herzog ◽  
Gerald S. Gilchrist ◽  
Suzanne L. Wolden ◽  
...  
Keyword(s):  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Low Dose ◽  
Hodgkin’S Disease ◽  
Complete Response ◽  
Study Entry ◽  
Rank Test ◽  
Log Rank Test ◽  
Involved Field ◽  
To Receive

PURPOSE: Current standard therapy for children and adolescents with Hodgkin’s disease includes combination chemotherapy and low-dose involved-field radiation (LD-IFRT). Because radiation may be associated with adverse late effects, the Children’s Cancer Group (CCG) investigated whether radiation could be omitted in patients achieving a complete response to initial chemotherapy without jeopardizing the excellent outcome obtained with combined-modality therapy. PATIENTS AND METHODS: Between January 1995 and December 1998, 829 eligible patients were enrolled onto CCG 5942. A total of 501 patients who achieved an initial complete response after risk-adapted combination chemotherapy were randomized to receive LD-IFRT or no further treatment. Event-free survival (EFS) and overall survival were assessed from the date of study entry or the date of randomization, as appropriate. RESULTS: The projected 3-year EFS from study entry for the entire cohort was 87% ± 1.2%. Among patients who achieved a complete response to initial chemotherapy, 92% ± 1.9% of those randomized to receive LD-IFRT were alive and disease free 3 years after randomization, versus 87% ± 2.2% for patients randomized to receive no further therapy (stratified log-rank test; P = .057). With an “as-treated” analysis, 3-year EFS after randomization for the radiation cohort was 93% ± 1.7% versus 85% ± 2.3% for patients receiving no further therapy (stratified log-rank test; P = .0024). Three-year survival estimates for patients treated with and without LD-IFRT were 98% ± 1.1% for patients who received radiation and 99% ± 0.5% for patients who did not receive radiation. CONCLUSION: LD-IFRT after an initial complete response to risk-adapted chemotherapy improved EFS. At this time, there is no survival advantage for LD-IFRT, but follow-up remains short.

scholarly journals Pretreatment hematocrit as an independent prognostic variable in Hodgkin's disease

Blood ◽  
1986 ◽  
Vol 68 (2) ◽  
pp. 562-564 ◽  
Author(s):  
HS Jaffe ◽  
EC Cadman ◽  
LR Farber ◽  
JR Bertino
Keyword(s):  
Prognostic Factors ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Advanced Stage ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Prognostic Variable ◽  
Therapy Program ◽  
Combined Modality

Pretreatment hematocrit in 117 advanced-stage Hodgkin's disease patients treated with a combined modality therapy program was evaluated as an independent prognostic variable with regard to survival and relapse-free survival. Age greater than 40 years, and multiple extranodal sites of involvement were found to be statistically significant independent negative prognostic factors with regard to survival. Pretreatment hematocrit, however, was not an independent negative prognostic variable.

scholarly journals Pretreatment hematocrit as an independent prognostic variable in Hodgkin's disease

Blood ◽  
1986 ◽  
Vol 68 (2) ◽  
pp. 562-564 ◽  
Author(s):  
HS Jaffe ◽  
EC Cadman ◽  
LR Farber ◽  
JR Bertino
Keyword(s):  
Prognostic Factors ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Advanced Stage ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Prognostic Variable ◽  
Therapy Program ◽  
Combined Modality

Abstract Pretreatment hematocrit in 117 advanced-stage Hodgkin's disease patients treated with a combined modality therapy program was evaluated as an independent prognostic variable with regard to survival and relapse-free survival. Age greater than 40 years, and multiple extranodal sites of involvement were found to be statistically significant independent negative prognostic factors with regard to survival. Pretreatment hematocrit, however, was not an independent negative prognostic variable.

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.

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