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.

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.

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.

Extended-field radiotherapy is superior to MOPP chemotherapy for the treatment of pathologic stage I-IIA Hodgkin's disease: eight-year update of an Italian prospective randomized study.

1992 ◽  
Vol 10 (3) ◽  
pp. 378-382 ◽  
Author(s):  
G P Biti ◽  
G Cimino ◽  
C Cartoni ◽  
S M Magrini ◽  
A P Anselmo ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Randomized Study ◽  
Group Analysis ◽  
Prognostic Indicator ◽  
Adult Patients ◽  
Stage I ◽  
Pathologic Stage ◽  
Extended Field

PURPOSE To compare the effectiveness of chemotherapy (CHT) with extended-field radiotherapy (RT) in the treatment of early-stage Hodgkin's disease (ESHD), we report an 8-year updated analysis of a study in which treatment with six cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) CHT was randomly compared with extended-field RT. PATIENTS AND METHODS From August 1979 to December 1982, 89 adult patients with pathologic stage I-IIA Hodgkin's disease (HD) were randomly allocated to receive either RT with mantle field followed by periaortic irradiation (n = 45) or six monthly courses of MOPP CHT (n = 44). RESULTS All patients in the RT arm and 40 of 44 in the CHT arm achieved complete remission. Twelve relapses occurred in each group. Eight patients treated with MOPP and two of the RT arm died of HD. Three other patients of the CHT group died because of a second cancer. With a median follow-up greater than 8 years, the overall survival rate is significantly higher in the RT than in the CHT group (93% v 56%; P less than .001), whereas the rates of freedom from progression and relapse-free survival (RFS) were similar in the two groups (76% v 64% and 70% v 71%, respectively). Of the 12 patients relapsing after RT, 11 (92%) achieved a second CR, compared with only six of the 12 (50%) in the MOPP group. Analysis of the response rate to salvage treatments showed that the type of relapse in the MOPP group was a prognostic indicator for the achievement of a second CR, whereas in the RT group, a second CR was obtained regardless of the characteristics of the relapses. At 80 months, the probability of survival of relapsing patients calculated from time of relapse was 85% and 15% in the RT and CHT groups, respectively (P = .02). CONCLUSION We conclude that RT alone is the treatment of choice for adult patients with ESHD with favorable prognostic factors.

Stage I/II Hodgkin’s Disease: Comparison of Outcomes of Patients with Bulky Mediastinal Disease Versus Other Risk Factors; the Stanford V Experience.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2316-2316
Author(s):  
Ranjana H. Advani ◽  
Richard T. Hoppe ◽  
Saul A. Rosenberg ◽  
Sandra J. Horning
Keyword(s):  
Risk Factors ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Stage I ◽  
Breast Cancers ◽  
Nodal Involvement ◽  
European Organization ◽  
Early Stage Disease ◽  
Mediastinal Disease

Abstract At Stanford, stage I/II Hodgkin’s Disease (HD) with a mediastinal mass ratio ≥ 1/3 (MMR ≥ 1/3) is considered unfavorable (U) and is treated like advanced disease. However, in contrast to the German Hodgkin Study Group (GHSG) or the European Organization for Research and Treatment of Cancer (EORTC), stage I/IIA disease without MMR ≥ 1/3 but with other risk factors such as ≥ 3 nodal sites, ESR ≥ 50 and extra-nodal involvement are not considered unfavorable nor used in risk stratification. The purpose of this study is to evaluate and compare the outcomes of patients (pt) treated uniformly at Stanford with early stage disease considered to be unfavorable due to MMR ≥ 1/3 to those with other adverse factors as defined by the GHSG or the EORTC. In this retrospective analysis we identified from our lymphoma database pt with stage I/II HD with a MMR ≥ 1/3 or stage I/IIA without MMR ≥ 1/3 but with 1 or more risk factors (≥ 3 nodal sites, ESR ≥50, extra-nodal involvement) with a minimum follow-up of 2 years. Pt with MMR ≥ 1/3 were treated with 12 weeks of Stanford V chemotherapy + 36 Gy radiotherapy (RT) to sites of disease ≥5 cm (SV–12 + 36 Gy). Stage I/IIA pt without MMR ≥ 1/3 but with other risk factors were treated on our early stage protocols with 8 weeks of Stanford V chemotherapy + 20 or 30 Gy RT to involved sites (SV–8 + 20/30 Gy IFRT). 120 pt were identified: 56 pt with Stage I/II and MMR ≥ 1/3 treated with SV–12 + 36 Gy and 64 stage I/IIA pt without MMR ≥1/3 but with risk factors treated with SV–8 + 20 Gy (n=16) or SV–8 + 30 Gy (n=48). The estimated freedom from progression (FFP) and overall survival (OS) are shown below. Treatment was unsuccessful in eleven pt (SV–12 + 36 Gy, n=5 and SV–8 + 20–30, Gy n=6). Relapse was limited to the RT field in 3 pt and combined with distant disease in another 6 pt. Secondary therapy was successful in 2 of the 5 pt with SV–12 + Gy and in 5 of six pt after SV–8 + 20/30 Gy IFRT. Fertility appears to be preserved with twenty-five live births/pregnancies reported. Six second cancers have been reported (2 breast, 2 skin, 1 cervix and 1 post transplant AML). Both the breast cancers occurred in females > 35 ys at diagnosis. In our series, abbreviated chemo-radiotherapy as delivered in SV–8 + 20/30 Gy IFRT to pt with stage I/IIA HD without MMR ≥ 1/3 but with risk factors as identified by the GHSG and EORTC has excellent outcomes comparable to those of the GHSG (HD11) and EORTC (HD9U) which use more intensive treatments. Stage I/II MMR ≥ 1/3 pt treated with SV–12 + 36 Gy also enjoyed excellent FFP and OS but second-line treatment was less successful in this group. These results have implications for balancing the risks and benefits of highly successful treatment strategies. Outcome Risk Factor (RF) n % 10 y FFP {95 % CI} % 10 y OS {95 % CI} Stage I/II with MMR > 1/3 56 90.6 {83, 99} 89 {80, 98} Stage I/II A (No MMR > 1/3) but other RF 64 90.4 {83, 98} 97 {92, 100}

Mantle Irradiation Alone for Clinical Stage I-II Hodgkin's Disease: Long-Term Follow-Up and Analysis of Prognostic Factors in 261 Patients

1999 ◽  
Vol 17 (1) ◽  
pp. 230-230 ◽  
Author(s):  
A. Wirth ◽  
M. Chao ◽  
J. Corry ◽  
C. Laidlaw ◽  
K. Yuen ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Progression Free Survival ◽  
Stage I ◽  
Stage Ii ◽  
Multifactor Analysis

PURPOSE: To evaluate mantle radiotherapy (MRT) alone as the initial therapy of patients with clinical stage (CS) I-II Hodgkin's disease (HD). PATIENTS AND METHODS: We performed a retrospective study of patients treated with MRT alone for CS I-II supradiaphragmatic HD between 1969 and 1994. Prognostic factor analysis was performed for progression-free survival (PFS) and overall survival (OS). Outcome was also assessed in favorable cohorts defined in the literature. RESULTS: There were 261 eligible patients. The median follow-up period for surviving patients was 8.4 years (range, 1.8 to 27.4 years). The 10-year OS rate was 73%. Multifactor analysis for OS showed that age was the only important prognostic factor. The 10-year PFS rate was 58%. On multifactor analysis for PFS, the most important prognostic factors were clinical stage, B symptoms, histology, number of sites, and tumor bulk. The 10-year PFS rate for lymphocyte-predominant disease was 81% for stage I and 78% for stage II. In favorable patient cohorts defined in the literature, the 10-year PFS rate ranged from 70% to 73% for the whole group and from 71% to 90% in patients with favorable stage I disease, but only from 48% to 57% in patients with favorable stage II disease. On competing-risks analysis, the cumulative 10-year incidence of first site of failure in the para-aortic/splenic region alone was 10.5%. Sixty percent of relapsed patients remain progression-free at 10 years after chemotherapy salvage. CONCLUSION: These results support the use of MRT alone in patients with favorable CS I HD and CS I-II HD with lymphocyte-predominant histology. The remainder of patients with CS I-II HD require more intensive treatment.

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.

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