Low-Dose Radiation Is Sufficient for the Noninvolved Extended-Field Treatment in Favorable Early-Stage Hodgkin’s Disease: Long-Term Results of a Randomized Trial of Radiotherapy Alone

2001 ◽  
Vol 19 (11) ◽  
pp. 2905-2914 ◽  
Author(s):  
Eckhart Dühmke ◽  
Jeremy Franklin ◽  
Michael Pfreundschuh ◽  
Susanne Sehlen ◽  
Norman Willich ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Survival Rates ◽  
Long Term Results ◽  
Good Survival ◽  
Protocol Violation ◽  
Extended Field ◽  
Splenic Disease

PURPOSE: To show that radiotherapy (RT) dose to the noninvolved extended field (EF) can be reduced without loss of efficacy in patients with early-stage Hodgkin’s disease (HD). PATIENTS AND METHODS: During 1988 to 1994, pathologically staged patients with stage I or II disease who were without risk factors (large mediastinal mass, extranodal lesions, massive splenic disease, elevated erythrocyte sedimentation rate, or three or more involved areas) were recruited from various centers. All patients received 40 Gy total fractionated dose to the involved field areas but were randomly assigned to receive either 40 Gy (arm A) or 30 Gy (arm B) total fractionated dose for the clinically noninvolved EF. No chemotherapy was given. RT films were prospectively reviewed for protocol violations and recurrences retrospectively related to the applied RT. RESULTS: Of 382 recruited patients, 376 were eligible for randomized comparison, 190 in arm A and 186 in arm B. Complete remission was attained in 98% of patients in each arm. With a median follow-up of 86 months, 7-year relapse-free survival (RFS) rates were 78% (arm A) and 83% (arm B) (P = .093). The upper 95% confidence limit for the possible inferiority of arm B in RFS was 4%. Corresponding overall survival rates were 91% (arm A) and 96% (arm B) (P = .16). The most common causes of death (n = 27) were cardiorespiratory disease/pulmonary embolisms (seven), second malignancy (six), and HD (five). Protocol violation was associated with significantly poorer RFS. Nonirradiated nodes were involved in 42 of 52 reviewed relapses, infield areas in 18, marginal areas in 17, and extranodal sites in 16. CONCLUSION: EF-RT alone attains good survival rates in favorable early-stage HD. The 30-Gy dose is adequate for clinically noninvolved areas. Protocol violation worsens the subsequent prognosis. Relapse patterns suggest that systemic therapy can reduce the 20% long-term relapse rate.

Long-term Results of 100 Cases of Hodgkin's Disease treated with Chemoterapy

1967 ◽  
Vol 53 (2) ◽  
pp. 111-128 ◽  
Author(s):  
Sergio Di Pietro
Keyword(s):  
Survival Rate ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Long Term Results ◽  
Good Survival ◽  
Fourth Stage ◽  
X Ray ◽  
The Third

Long-term results of 100 cases of Hodgkin's disease, treated with chemotherapy associated or not with X-ray therapy from 1949 to 1900, are reported. The median, survival rate was of 36 months: at 5 years the rate was 25 %. The survival rate at 5 years was 34,2 % for the 38 women and 19.3 % for the 62 men treated. Of 66 cases of the third clinical stage 31.6 % was alive at 5 years; the corresponding value for the 40 cases of the fourth stage was 15 %. The best survival rate was observed in the group of women of the third clinical stage with involvement of ilo-mediastinic lymph nodes in the first period of the disease (52.6% at 5 years). As to the four histological varieties of our cases, one can observe that the «paragranuloma» and the «scleronodular» types show a fairly good survival rate, not depending on the clinical stage, whereas the «polymorphous» and «sarcomatous» ones cause a more severe prognosis for the patients of the fourth clinical stage. The age of the patients, evidence or not of « systemic » symptoms, and the duration of the disease before the first treatment don't seem to have any significant influence on the survival rate. The best results were obtained with chemotherapy-X-ray therapy association in the group of patients of the third stage (survival rate of 39.5 % at 5 years). No difference is noted, on the contrary, between long-term results of chemotherapy alone and those of chemotherapy associated with X-therapy in the fourth stage.

Influence of more extensive radiotherapy and adjuvant chemotherapy on long-term outcome of early-stage Hodgkin's disease: a meta-analysis of 23 randomized trials involving 3,888 patients. International Hodgkin's Disease Collaborative Group.

1998 ◽  
Vol 16 (3) ◽  
pp. 830-843 ◽  
Author(s):  
L Specht ◽  
R G Gray ◽  
M J Clarke ◽  
R Peto
Keyword(s):  
Hodgkin's Disease ◽  
Randomized Trials ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Survival Rates ◽  
Collaborative Group ◽  
Mortality Data ◽  
Term Outcome ◽  
Long Term Outcome

PURPOSE To assess the effect of more extensive radiotherapy and of adjuvant combination chemotherapy on long-term outcome of early-stage Hodgkin's disease. METHODS In a collaborative worldwide systematic overview, individual patient data were centrally reviewed on 1,974 patients in eight randomized trials of more versus less extensive radiotherapy and on 1,688 patients in 13 trials of radiotherapy plus chemotherapy versus radiotherapy alone. Crude mortality data on 226 patients in two other trials of chemotherapy were also reviewed. RESULTS More extensive radiotherapy reduced the risk of treatment failure (resistant or recurrent disease) at 10 years by more than one third (31.3% v 43.4% failures; P < .00001), but there was no apparent improvement in overall 10-year survival (77.1 % v 77.0% alive). The addition of chemotherapy to radiotherapy halved the 10-year risk of failure (15.8% v 32.7%; P < .00001), with a small, nonsignificant improvement in survival (79.4% v 76.5% alive). This involved a reduction of borderline significance for deaths from Hodgkin's disease (12.3% v 15.4% dead at 10 years; P = .07), which was partly counterbalanced by a nonsignificant excess of deaths from other causes (12.4% v 10.0% 10-year risk). CONCLUSION More extensive radiotherapy fields or the addition of chemotherapy to radiotherapy in the initial treatment of early-stage Hodgkin's disease had a large effect on disease control, but only a small effect on overall survival. Recurrences could be prevented by more extensive radiotherapy or by additional chemotherapy. However, if chemotherapy had not been given initially, recurrences were generally salvageable by re-treatment with chemotherapy. Hence, less intensive primary treatment--particularly a reduction in radiotherapy fields--appears to achieve similar survival rates as more intensive treatment, although more randomized evidence is needed to confirm this.

Stage I-II pediatric Hodgkin's disease: long-term follow-up demonstrates equivalent survival rates following different management schemes.

1990 ◽  
Vol 8 (7) ◽  
pp. 1128-1137 ◽  
Author(s):  
S S Donaldson ◽  
S J Whitaker ◽  
P N Plowman ◽  
M P Link ◽  
J S Malpas
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Survival Rates ◽  
Stage I ◽  
Management Policy ◽  
Clinical Staging ◽  
Pathologic Staging ◽  
Field Radiation ◽  
Extended Field

The results of treatment of 171 children with stage I-II Hodgkin's disease from two institutions with differing approaches to management have been analyzed. At the Stanford University Medical Center/Children's Hospital at Stanford (SUMC/CHaS), pathologic staging followed by extended-field radiation alone or involved-field radiation plus combination chemotherapy have been cardinal to the management policy. At St Bartholomew's Hospital/The Hospital for Sick Children at Great Ormond Street (Barts/GOS), clinical staging only has been used over the last 10 years, and involved/regional-field radiotherapy used as the treatment of choice rather than extended-field radiotherapy. Some children at each institution received combined modality therapy as primary management. Relapse among children with stage I disease was a more frequent occurrence in the Barts/GOS series than in the SUMC/CHaS group. However, the survival rates from the two centers are identical, 91% at 10 years. The following scientific-philosophic question is asked: Should one maximally stage and treat all children to increase the likelihood of a high freedom from relapse (FFR; cure) rate, or is it acceptable to minimize the initial staging and treatment, realizing that a proportion of patients will fail and require salvage/rescue therapy? With the awareness of morbidity from pathologic staging and aggressive treatment, and the favorable survival data reported from specialized centers using differing approaches, treatment strategies should be directed toward the long-term goal of cure of disease with maximal quality of life. A multidisciplinary management philosophy undertaken at a center with extensive experience in pediatric Hodgkin's disease is important to achieving this goal.

scholarly journals Long-term results of a prospective trial of mantle irradiation alone for early-stage Hodgkin's disease

2006 ◽  
Vol 17 (11) ◽  
pp. 1693-1697 ◽  
Author(s):  
A.K. Ng ◽  
S. Li ◽  
D. Neuberg ◽  
D.C. Fisher ◽  
C. McMillan ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Prospective Trial ◽  
Long Term Results

Combined-Modality Therapy Versus Radiotherapy Alone for Treatment of Early-Stage Hodgkin's Disease: Cure Balanced Against Complications

2006 ◽  
Vol 24 (4) ◽  
pp. 605-611 ◽  
Author(s):  
Bridget F. Koontz ◽  
John P. Kirkpatrick ◽  
Robert W. Clough ◽  
Robert G. Prosnitz ◽  
Jon P. Gockerman ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Long Term Results ◽  
Cardiac Complications ◽  
Second Malignancies ◽  
Combined Modality ◽  
Radiotherapy Alone

Purpose The treatment of early-stage Hodgkin's disease (HD) has evolved from radiotherapy alone (RT) to combined-modality therapy (CMT) because of concerns about late adverse effects from high-dose subtotal nodal irradiation (STNI). However, there is little information regarding the long-term results of CMT programs that substantially reduce the dose and extent of radiation. In addition, lowering the total radiation dose may reduce the complication rate without compromising cure. This retrospective study compares the long-term results of STNI with CMT using modestly reduced RT dose in the treatment of early-stage HD. Patients and Methods Between 1982 and 2002, 111 patients with stage IA and IIA HD were treated definitively with RT (mean dose, 37.9 Gy); 70 patients were treated with CMT with low-dose involved-field radiotherapy (LDIFRT; mean dose, 25.5 Gy). Median follow-up was 11.7 years for RT patients and 8.1 years for the CMT group. Results There was a trend toward improved 20-year overall survival with CMT (83% v 70%; P = .405). No second cancers were observed in the CMT group; in the RT group the actuarial frequency of a second cancer was 16% at 20 years. There was no difference in the frequency of cardiac complications (9% v 6%, RT v CMT). Conclusion In this retrospective review, CMT with LDIFRT was effective in curing early-stage HD and was not associated with an increase in second malignancies. For RT alone, a moderate dose seemed to reduce cardiac complications but did not lessen second malignancies compared with higher doses used historically.

Radiation therapy in early stage Hodgkin's disease: long-term results and adverse effects

2002 ◽  
Vol 3 (4) ◽  
pp. 179-184 ◽  
Author(s):  
Josée M Zijlstra ◽  
A J Nicolette Dressel ◽  
Jan Willem Mens ◽  
Harm v Tinteren ◽  
Ben J Slotman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adverse Effects ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Long Term Results

ABVD Plus Subtotal Nodal Versus Involved-Field Radiotherapy in Early-Stage Hodgkin's Disease: Long-Term Results

2004 ◽  
Vol 22 (14) ◽  
pp. 2835-2841 ◽  
Author(s):  
Gianni Bonadonna ◽  
Valeria Bonfante ◽  
Simonetta Viviani ◽  
Anna Di Russo ◽  
Fabrizio Villani ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Statistical Power ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Prospective Trial ◽  
Patient Characteristics ◽  
Long Term Results ◽  
Involved Field ◽  
Involved Field Radiotherapy

Purpose Radiation therapy (RT) alone can cure more than 80% of all patients with pathologic stage IA, IB, and IIA Hodgkin's disease, but some prognostic factors unfavorably affect treatment outcome. Combined-modality approaches improved results compared with RT, but the optimal extent of RT fields when combined with chemotherapy warranted additional evaluation. Patients and Methods In February 1990, we activated a prospective trial in patients with early, clinically staged Hodgkin's disease to assess efficacy and tolerability of four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by either subtotal nodal plus spleen irradiation (STNI) or involved-field radiotherapy (IFRT). Results Main patient characteristics were fairly well balanced between the two arms. Complete remission was achieved in 100% and in 97% of patients, respectively. The 12-year freedom from progression rates were 93% (95% CI, 83% to 100%) after ABVD and STNI, and 94% (95% CI, 88% to 100%) after ABVD and IFRT, whereas the figures for overall survival were 96% (95% CI, 91% to 100%) and 94% (95% CI, 89% to 100%), respectively. Apart from three patients who developed second malignancies in the STNI arm, treatment-related morbidities were mild. Conclusion Present long-term findings suggest that, after four cycles of ABVD, IFRT can achieve a worthwhile outcome. The limited size of our patient sample, however, had no adequate statistical power to test for noninferiority of IFRT versus STNI. Despite this, ABVD followed by IFRT can be considered an effective and safe modality in early Hodgkin's disease with both favorable and unfavorable presentation.

scholarly journals Early-stage Hodgkin's disease: Long-term results with radiotherapy alone or combined radiotherapy and chemotherapy

1994 ◽  
Vol 5 ◽  
pp. S101-S106 ◽  
Author(s):  
E. Brusamolino ◽  
M. Lazzarino ◽  
E. Orlandi ◽  
A. Canevari ◽  
E. Morra ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Long Term Results ◽  
Radiotherapy Alone
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