Radiation therapy salvage of Hodgkin's disease following chemotherapy failure.

1987 ◽  
Vol 5 (1) ◽  
pp. 38-45 ◽  
Author(s):  
K A Fox ◽  
S M Lippman ◽  
J R Cassady ◽  
R S Heusinkveld ◽  
T P Miller
Keyword(s):  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Statistical Significance ◽  
Disease Free Survival ◽  
Complete Response ◽  
Salvage Radiotherapy ◽  
Wide Field ◽  
Response To Chemotherapy ◽  
Advanced Hodgkin’S Disease

Between 1972 and 1984, 17 patients with advanced Hodgkin's disease failing intensive combination chemotherapy in previously unirradiated nodal and/or pulmonary sites were treated with salvage radiotherapy. Treatment consisted of comprehensive wide field radiotherapy to all known areas of disease. Doses administered to these fields ranged from 1,700 to 5,000 rad, with only three patients (18%) receiving less than 3,000 rad to any field. With a median follow-up of over 4 years, 88% achieved a complete response, with median actuarial disease-free survival (DFS) of 19 months (range, 4 to 61+). Actuarial median survival was 64 months, with a range of 4 to 134+ months. Nine patients (53%) are currently alive with three (18%) in continuous complete remission (CR) for 24, 30, and 61 months. In addition, four patients relapsing after salvage radiotherapy are now in CR following additional therapy. Patients younger than 35 years of age had a significantly increased overall survival when compared with older patients (P less than .005). An initial complete response to chemotherapy lasting 12 or more months appeared to be a favorable prognostic factor, although small patient numbers preclude statistical significance. Comprehensive salvage radiotherapy is of significant benefit in patients with advanced Hodgkin's disease relapsing after combination chemotherapy in nodal and/or pulmonary sites.

Alternating cycles of combination chemotherapy for patients with recurrent Hodgkin's disease following radiotherapy. A prospectively randomized study by the Cancer and Leukemia Group B.

1986 ◽  
Vol 4 (6) ◽  
pp. 838-846 ◽  
Author(s):  
V Vinciguerra ◽  
K J Propert ◽  
M Coleman ◽  
J R Anderson ◽  
L Stutzman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Disease Free Survival ◽  
Complete Response ◽  
Free Survival ◽  
Group B ◽  
Leukemia Group ◽  
Disease Free

A randomized clinical trial of combination chemotherapy for patients who relapsed following primary radiation therapy for Hodgkin's disease was conducted from 1975 to 1981 by the Cancer and Leukemia Group B (CALGB). One hundred thirteen patients were prospectively randomized to receive 12 cycles of either CVPP (CCNU, vinblastine, procarbazine, and prednisone), ABOS (bleomycin, vincristine [Oncovin; Lilly, Indianapolis], doxorubicin [Adriamycin, Adria Laboratories, Columbus, Ohio], and streptozotocin), or alternating cycles of CVPP and ABOS. The median length of observation for patients in this report is 4 years. Toxicities of the three treatment programs were primarily hematologic. Frequencies of complete response were 72% for CVPP, 70% for ABOS, and 82% for CVPP/ABOS (P = .37). Females and patients who had nodular sclerosing disease at initial diagnosis had significantly higher complete response rates. The 5-year disease-free survival for the complete responders was 55%; the 5-year overall survival was 60%. There were no significant differences among the treatments on disease-free survival (P = .78) or overall survival (P = .18). Age under 40 years was the only significant positive prognostic factor for disease-free survival (P = .095) and overall survival (P = .003). This study demonstrates no statistically significant advantage for alternating cycles of combination chemotherapy in affecting complete response frequency, disease-free survival, or overall survival as compared with therapy with CVPP or ABOS alone. However, the power to detect differences in these outcome parameters is somewhat limited by the sample sizes.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiotherapy with curative intent: an option in selected patients relapsing after chemotherapy for advanced Hodgkin's disease.

1987 ◽  
Vol 5 (4) ◽  
pp. 550-555 ◽  
Author(s):  
M Roach ◽  
D S Kapp ◽  
S A Rosenberg ◽  
R T Hoppe
Keyword(s):  
Radiation Therapy ◽  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Complete Response ◽  
Curative Intent ◽  
Major Toxicity ◽  
Disease Free ◽  
Advanced Hodgkin’S Disease

Thirteen patients who had relapsed or failed to obtain a complete remission after combination chemotherapy for the treatment of advanced Hodgkin's disease were treated with subtotal or total lymphoid irradiation with curative intent. Twelve of the 13 patients achieved a complete response (CR). Five of the 12 CRs subsequently relapsed at 3, 9, 9, 12, and 19 months. One patient died of leukemia 11 months following radiotherapy. The actuarial relapse-free survival at 1 year was 60%, and six patients (50%) remain disease-free with a median follow-up of 34 months (range, 10 to 115 months) following the completion of radiotherapy. Patients who failed to obtain a CR to their initial chemotherapy, whose chemotherapy CR was of short duration, or who relapsed initially in extranodal sites, tended to have a worse outcome with radiotherapy. Patients who had long disease-free intervals after initial chemotherapy or relapsed only in nodal sites tended to do relatively well. Radiation therapy was well tolerated with no major toxicity. Potentially curative radiation therapy should be considered an option in the management of selected patients who relapse following combination chemotherapy for advanced Hodgkin's disease.

Combination Chemotherapy of Advanced Hodgkin’s Disease with Adriamycin, DTIC, CCNU, and Bleomycin

Chemotherapy ◽  
1976 ◽  
pp. 513-516
Author(s):  
R. Osieka ◽  
U. Bruntsch ◽  
W. M. Gallmeier ◽  
S. Seeber ◽  
C. G. Schmidt
Keyword(s):  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Advanced Hodgkin’S Disease

Treatment of advanced Hodgkin's disease with chemotherapy--comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group.

1997 ◽  
Vol 15 (4) ◽  
pp. 1638-1645 ◽  
Author(s):  
J M Connors ◽  
P Klimo ◽  
G Adams ◽  
B F Burns ◽  
I Cooper ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Survival Rates ◽  
Prospective Trial ◽  
Treatment Center ◽  
Wide Field ◽  
Free Survival ◽  
Significant Difference ◽  
The Difference ◽  
Advanced Hodgkin’S Disease

PURPOSE This randomized, prospective trial compares outcomes for patients with advanced Hodgkin's disease treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, and vinblastine (ABV) hybrid regimen or alternating MOPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). METHODS Three hundred one patients with advanced Hodgkin's disease were randomized to receive MOPP/ ABV hybrid regimen or alternating MOPP/ABVD after stratification for prior treatment, B symptoms, and treatment center. Eligible patients were either previously untreated and found to have stage IIIB, IVA, or IVB disease or previously treated with wide-field irradiation. Responding patients received a minimum of eight cycles of chemotherapy. Those with residual disease in a localized region received irradiation between the sixth and seventh cycle of treatment. RESULTS Response rates to the two regimens were similar. Five-year overall survival rates were 81% and 83% for MOPP/ABV hybrid and alternating MOPP/ ABVD, respectively (P = .74; 95% confidence interval [CI] for the difference, -11% to 7%). Five-year failure-free survivals were 71% and 67% for MOPP/ABV hybrid and alternating MOPP/ABVD, respectively (P = .87; 95% CI for the difference, -9% to 17%). Significantly more episodes of febrile neutropenia and stomatitis were observed with the MOPP/ABV hybrid regimen; there was no significant difference in fatal toxicity. Patients with predefined, high-quality partial responses (PR-1s) had results similar to those with complete responses (CRs). Planned subset analysis showed no significant difference in outcome between the two arms of the trial for patients with newly diagnosed disease (5-year failure-free survival rates were 70% for MOPP/ABV hybrid and 59% for alternating MOPP/ABVD; P = .180), but superiority of alternating MOPP/ABVD for patients with prior irradiation (5-year failure-free survival 94% v 73%; P = .017). CONCLUSION MOPP/ABV hybrid and alternating MOPP/ABVD regimens are equally effective for patients with advanced Hodgkin's disease.

Outcome of Hodgkin's Disease in Children with Chemotherapy alone in a Resource Limited Country

2017 ◽  
Vol 1 (01) ◽  
pp. 5-8
Author(s):  
ATM Atikur Rahman ◽  
Farida Yasmin ◽  
Momena Begum ◽  
Tanvir Ahammed ◽  
Afiqul Islam
Keyword(s):  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin’S Disease ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
Present Moment ◽  
Outpatient Basis ◽  
Open Label ◽  
Quasi Experimental

Background: Treatment of Hodgkin's lymphoma involves both chemotherapy and radiotherapy. But radiotherapy in children is associated with risk of development of long-term complications like the development of second malignancy. Novel therapeutic strategies with combination chemotherapy without radiotherapy are being used to reduce such complications while maintaining the optimum response. Objective: To investigate the outcome of treatment of Hodgkin's Lymphoma with combination chemotherapy ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) alone.  Patients and methods: A quasi-experimental open label clinical study was done on 48 children with Hodgkin's lymphoma in the Paediatric Haemato-Oncology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) with eight cycle ABVD regime on an outpatient basis over a period of 8 months to see the outcome of treatment. Results: The mean age of the patients was 10.3 years (range 3-16). There were 42 males and 6 females. Mixed cellularity cHL was the commonest histological subtype observed 20/48 (42%) patients. Forty-two (88%) patients achieved complete response (CR), 5 (10%) had partial response (PR) and one patient did not respond at all. Fifteen patients (31%) are known to be dead and the rest are alive and tumour free. Median EFS and OS were not achieved. The EFS and OS at 5 years were 63% and 67% respectively. Conclusion: ABVD combination should be regarded at the present moment as the simplest and most effective drug therapy for treating childhood Hodgkin's disease.

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.

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