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.

Infradiaphragmatic Hodgkin's Disease: Long Term Results of Combined Modality Therapy

1996 ◽  
Vol 21 (1-2) ◽  
pp. 79-84 ◽  
Author(s):  
Norbert Ifrah ◽  
Mathilde Hunault ◽  
Jean-Philippe Jais ◽  
Philippe Moreau ◽  
Bernard Desablens ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Long Term Results ◽  
Combined Modality

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

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.

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

scholarly journals Long term remissions with combined modality therapy for advanced Hodgkin's disease

Cancer ◽  
1976 ◽  
Vol 37 (6) ◽  
pp. 2826-2833 ◽  
Author(s):  
Leonard R. Prosnitz ◽  
Leonard R. Farber ◽  
James J. Fischer ◽  
Joseph R. Bertino ◽  
Diana B. Fischer
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Combined Modality ◽  
Advanced Hodgkin’S Disease

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 The management of stage I--II Hodgkin's disease with irradiation alone or combined modality therapy: the Stanford experience

Blood ◽  
1982 ◽  
Vol 59 (3) ◽  
pp. 455-465 ◽  
Author(s):  
RT Hoppe ◽  
CN Coleman ◽  
RS Cox ◽  
SA Rosenberg ◽  
HS Kaplan
Keyword(s):  
Hodgkin's Disease ◽  
Mediastinal Mass ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Stage I ◽  
Actuarial Survival ◽  
Histologic Subtype ◽  
Combined Modality ◽  
Systemic Symptoms

Abstract At Stanford University, between 1968 and 1978, 230 patients with pathologic stage I--II Hodgkin's disease were treated on prospective clinical trials with either irradiation alone or irradiation followed by 6 cycles of adjuvant combination chemotherapy. The actuarial survival at 10 yr was 84% for patients in either treatment group. Freedom from relapse at 10 yr was 77% among patients treated with irradiation alone and 84% after treatment with combined modality therapy [p(Gehan) = 0.09]. Freedom from second relapse at 10 yr was 89% and 94%, respectively [p(Gehan) = 0.56]. Several prognostic factors were evaluated in order to identify patients at high risk for relapse or with poor ultimate survival after initial treatment with irradiation alone. Systemic symptoms, histologic subtype, age, and limited extranodal involvement (E-lesions) did not affect the prognosis of patients and failed to identify patients whose survival could be improved by the routine use of combined modality therapy. Patients with large mediastinal masses (mediastinal mass ratio greater than or equal to 1/3) had a significantly poorer freedom from relapse when treated with irradiation alone than when treated initially with combined modality therapy [45% versus 81% at 10 yr, p(Gehan) = 0.03). The 10-yr survival of these patients, however, was not significantly different (84% versus 74%). The implications of these observations on the management of patient with early stage Hodgkin's disease are discussed.

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