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Canadian Medical Association Journal Aug 1985Most patients with early-stage Hodgkin's disease can now be cured by one of several therapeutic approaches. This review highlights the developments in the diagnosis and... (Review)
Review
Most patients with early-stage Hodgkin's disease can now be cured by one of several therapeutic approaches. This review highlights the developments in the diagnosis and treatment of the disease that have led to long-term survival rates greater than 90%. Past and present radio-therapy (RT) planning and treatment practices are discussed in the context of both clinical and pathological staging. The role of initial bimodal therapy (RT and chemotherapy [CT]) and the use of CT in patients who suffer relapse after initial treatment with RT alone are reviewed. On the basis of prognostic factors, subgroups of patients for whom bimodal therapy is recommended, including those with a bulky mediastinal mass, have now been identified. Although treatment is highly successful, debilitating consequences of RT and CT, such as infertility, infection and second malignant diseases, remain. Newer treatment regimens may reduce morbidity and have similar or better long-term results with respect to survival and quality of life.
Topics: Acute Disease; Adult; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Female; Hodgkin Disease; Humans; Infertility; Leukemia; Lymphoma; Male; Mechlorethamine; Menstruation Disturbances; Neoplasm Staging; Prednisone; Procarbazine; Prognosis; Vincristine
PubMed: 3893668
DOI: No ID Found -
[Rinsho Ketsueki] the Japanese Journal... Aug 1989At Kanazawa University 28 patients with Hodgkin's disease were treated between 1975 and 1988. Ten patients underwent staging laparotomy by which we had to change the...
At Kanazawa University 28 patients with Hodgkin's disease were treated between 1975 and 1988. Ten patients underwent staging laparotomy by which we had to change the pathological stage in 3 patients because occult splenic lesions were detected histologically. Patients with early disease were treated mainly with radiotherapy (RT) and those with advanced disease received modified MOPP chemotherapy with or without RT. Twenty-six patients entered complete remission, and relapse occurred in 7 including 5 patients with stage III disease. Four patients died of the disease and 4 of other causes. The actuarial survival at 5 and 10 years were 80.1% and 47.1% respectively. The actuarial relapse free rate at 10 years was 65.8%. Fourteen patients are in good health after completion of treatment, and 9 healthy babies were born to 5 patients including 3 female patients. The goal of therapy in Hodgkin's disease is cure. Treatment strategy must be based on proper staging and consideration of iatrogenic morbidity such as sterility and second malignancy.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Child; Combined Modality Therapy; Female; Hodgkin Disease; Humans; Laparotomy; Male; Mechlorethamine; Middle Aged; Neoplasm Staging; Prednisone; Procarbazine; Remission Induction; Vincristine
PubMed: 2601031
DOI: No ID Found -
Journal of Clinical Oncology : Official... Jun 1989In order to assess whether mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy (CT), which is less expensive and more easily available than... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
In order to assess whether mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy (CT), which is less expensive and more easily available than radiotherapy (RT), is at least as effective as RT in terms of cure rate and has less iatrogenic damage, 89 consecutive patients with Hodgkin's disease (HD) (pathological stage I-IIA) were randomly allocated to receive mantle plus lumbar bar RT (36-45 Gy) or CT (six courses of MOPP). Forty-five patients were entered in the RT group and 44 in the CT group. The median follow-up was 60 months. Complete remission (CR) was obtained in all patients in the RT group and in 40 of 44 patients in the CT group. Overall survival (OS) and disease-free survival (DFS) were, respectively, 87.2% and 72.7% in the CT group and 93.5% and 74% in the RT group. Survival probability of relapsing patients was 76% for the patients in the RT group and 45% in the CT group. Treatment-related complications were more severe in the CT group as compared with the RT group.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Female; Hodgkin Disease; Humans; Male; Mechlorethamine; Middle Aged; Prednisone; Procarbazine; Random Allocation; Vincristine
PubMed: 2715803
DOI: 10.1200/JCO.1989.7.6.732 -
Journal of Neuro-oncology 1985Seventeen infants with central nervous system malignancies, all with tissue diagnosis, were treated with the combination chemotherapy nitrogen mustard, vincristine,...
Seventeen infants with central nervous system malignancies, all with tissue diagnosis, were treated with the combination chemotherapy nitrogen mustard, vincristine, procarbazine and a steroid (MOPP) as primary therapy following surgery. Diagnoses include: 7 astrocytomas (grade: 3-I, 3-II, 1-III), 6 medulloblastomas, 2 ependymoma/astrocytoma mixed, 1 ependymoma and 1 primitive neuroectodermal tumor. Fourteen were under 2 years of age, 2 between 2 and 3 years of age, and 1 between 3 and 4 years of age. Fifteen responded and 2 failed. Of the responders, 6 are in continuous complete remission (median duration 28.9+ months) and 9 are in relapse (median duration of remission 10.3 months). Of the 2 patients who failed and 9 who relapsed, 4 expired and 6 are living in partial or complete remission. We conclude that MOPP therapy is well tolerated, has effectiveness, and allows postponement of potentially debilitating radiotherapy in infants with brain tumors.
Topics: Antineoplastic Combined Chemotherapy Protocols; Astrocytoma; Brain Neoplasms; Cerebellar Neoplasms; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Mechlorethamine; Medulloblastoma; Prednisone; Procarbazine; Vincristine
PubMed: 3840526
DOI: 10.1007/BF00165184 -
Journal of Neuro-oncology 1994Medulloblastoma is a rare tumor in adult. High doses of megavoltage irradiation of the posterior fossa have been resulted in a better survival (48 to 78% at 5 years) of... (Review)
Review
Medulloblastoma is a rare tumor in adult. High doses of megavoltage irradiation of the posterior fossa have been resulted in a better survival (48 to 78% at 5 years) of the patient. It is sensitive to a wide variety of chemotherapy drugs, but adjuvant chemotherapy has not been proved effective in adults although data are limited. We report the case of a cerebellar medulloblastoma with bony and medullar metastases. High-dose chemotherapy with peripheral stem-cell transplantation was performed while the patient was in remission following conventional chemotherapy. Complete remission lasted for 8 months. This therapeutic approach of metastatic medulloblastoma might be of value as this tumor is chemosensitive and not cured by conventional treatment. Internal radiotherapy by Samarium-153 was also carried out and proved to be an effective palliative treatment of pain.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Marrow Transplantation; Cerebellar Neoplasms; Combined Modality Therapy; Dacarbazine; Doxorubicin; Humans; Male; Mechlorethamine; Medulloblastoma; Prednisone; Procarbazine; Stem Cell Transplantation; Vinblastine; Vincristine
PubMed: 7520058
DOI: 10.1007/BF01324599 -
CMAJ : Canadian Medical Association... Sep 1986Combination chemotherapy (CT) has been the mainstay of treatment of advanced-stage Hodgkin's disease since the late 1960s. Although treatment with MOPP (nitrogen... (Review)
Review
Combination chemotherapy (CT) has been the mainstay of treatment of advanced-stage Hodgkin's disease since the late 1960s. Although treatment with MOPP (nitrogen mustard, vincristine sulfate [Oncovin], procarbazine and prednisone) has resulted in long-term disease-free survival rates exceeding 50%, newer approaches have been studied to improve on this success rate and to reduce the toxic effects associated with MOPP. Prognostic factors have now been defined that identify patients who may require more aggressive treatment; they include age greater than 40 years, presence of B symptoms and more advanced (especially extranodal) disease. A small number of patients with pathological stage III disease may still be successfully treated with extensive radiotherapy (RT) alone. Among patients with advanced-stage disease, significantly better therapeutic results are being obtained with newer treatment approaches than with MOPP, particularly in patients with factors that predict a poor outcome. These newer approaches include combination CT plus RT, alternating cycles of two non-cross-resistant CT regimens and hybrid regimens, which combine agents from two different CT regimens in one cycle. The prognosis of patients who suffer relapse after combination CT remains poor, even with newer drug regimens. The newer treatment approaches may well lead to better cure rates and fewer short-term and long-term toxic effects.
Topics: Adult; Age Factors; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Dacarbazine; Doxorubicin; Drug Administration Schedule; Hodgkin Disease; Humans; Mechlorethamine; Neoplasm Staging; Prednisone; Procarbazine; Prognosis; Recurrence; Vinblastine; Vincristine
PubMed: 2427176
DOI: No ID Found -
European Journal of Cancer (Oxford,... 1992Approximately 20-25% of patients with stage I-II Hodgkin's disease treated initially with irradiation alone will experience a relapse of disease. Restaging at the time... (Review)
Review
Approximately 20-25% of patients with stage I-II Hodgkin's disease treated initially with irradiation alone will experience a relapse of disease. Restaging at the time of relapse provides a useful prognostic indicator and may help in the selection of salvage therapy. Systemic treatment is indicated in nearly all patients. In the Stanford experience, 109 patients who relapsed were treated with MOPP (or MOPP-like chemotherapy) with or without local irradiation. The actuarial 10-year survival and freedom from second relapse were both 57%. Important prognostic factors included 'relapse stage' (IA vs. II-IIIA vs. I-IIIB or IV) and type of salvage therapy (combined modality vs. chemotherapy alone). Important issues in management of these patients include the selection of chemotherapy agents, whether to incorporate localised irradiation, and the use of even more aggressive salvage treatment programs, such as autologous bone marrow transplantation, in selected patients with a very poor prognosis.
Topics: Antineoplastic Combined Chemotherapy Protocols; Hodgkin Disease; Humans; Mechlorethamine; Neoplasm Staging; Prednisone; Procarbazine; Prognosis; Recurrence; Salvage Therapy; Treatment Outcome; Vincristine
PubMed: 1389536
DOI: 10.1016/0959-8049(92)90036-2 -
Seminars in Oncology Dec 1985Chemotherapy of malignant lymphomas has entered the exciting era in which cure can be expected in a large portion of untreated patients, even those with advanced-stage... (Review)
Review
Chemotherapy of malignant lymphomas has entered the exciting era in which cure can be expected in a large portion of untreated patients, even those with advanced-stage disease. The major obstacle to complete remission is selection and overgrowth of a permanent, drug-resistant, neoplastic cell population. For this reason, a number of investigators have tested the efficacy of two or more non-cross-resistant regimens delivered in alternating fashion. In stage IV Hodgkin's disease, the MOPP-ABVD program increases the cure rate by 15% to 20% compared with MOPP alone. With intensive polydrug regimens, at least 50% of patients with diffuse large-cell non-Hodgkin's lymphomas (NHL) can now be cured. The risk of treatment-induced acute leukemias as well as sterility can be avoided or greatly decreased with drug combinations not including procarbazine HCI and alkylating agents. Effective salvage regimens for lymphomas resistant to primary chemotherapy have been described in part for Hodgkin's disease; a number of second-line treatments can probably cure 20% to 25% of MOPP-resistant patients. Encouraging results that require confirmation have also been reported in the treatment of relapsing NHL with drug combinations including cisplatin (Platinol), cytosine arabinoside, etoposide (VP-16), ifosfamide, and amsacrine. Salvage drug therapy combined with autologous bone marrow transplantation appears promising but, at present, remains experimental.
Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Dacarbazine; Doxorubicin; Drug Resistance; Hodgkin Disease; Humans; Leukemia; Lymphoma; Mechlorethamine; Neoplasm Staging; Prednisone; Procarbazine; Vinblastine; Vincristine
PubMed: 2417334
DOI: No ID Found -
Annals of Oncology : Official Journal... Feb 1991The long-term therapeutic results achieved in a previous randomized study on stage IV Hodgkin's disease confirm the superiority of MOPP monthly alternated with ABVD... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
The long-term therapeutic results achieved in a previous randomized study on stage IV Hodgkin's disease confirm the superiority of MOPP monthly alternated with ABVD compared to MOPP alone. To more closely meet the requirements of the Goldie and Coldman hypothesis, we activated a randomized study testing MOPP-ABVD through two different sequences in July 1982. One arm consisted of monthly alternating one cycle of MOPP and one cycle of ABVD; in the other arm, one half cycle of MOPP was alternated with one half cycle of ABVD within a one-month period (hybrid regimen). Each regimen was given to complete remission plus two consolidation cycles (minimum six cycles). After maximal tumor shrinkage, moderate doses of radiotherapy (25-30 Gy) were delivered to the lymphoid region(s) if bulky at the start of chemotherapy. A total of 300 patients with stage IB, IIA bulky, IIB, III (A + B) and IV Hodgkin's disease previously untreated with chemotherapy or failing after extensive irradiation were evaluated. At a median follow-up of five years, alternating and hybrid regimens yielded superimposable treatment outcomes: complete remission 89 versus 88%, freedom from first progression 65 versus 70%; relapse-free survival 72 versus 78%, overall survival 81 versus 80%, respectively. Tumor cell burden expressed as number of involved nodal sites and presence of pulmonary hilus involvement were the prognostic variables able to significantly influence treatment outcome. Conversely, stage, constitutional symptoms, and histology had no impact on the five-year results.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Dacarbazine; Doxorubicin; Drug Administration Schedule; Drug Resistance; Female; Follow-Up Studies; Hodgkin Disease; Humans; Lymphatic Metastasis; Male; Mechlorethamine; Neoplasms, Multiple Primary; Patient Compliance; Prednisone; Procarbazine; Prospective Studies; Radiotherapy Dosage; Recurrence; Remission Induction; Survival Rate; Vinblastine; Vincristine
PubMed: 1710921
DOI: 10.1007/978-1-4899-7305-4_9 -
Tumori Oct 1983Eighty-four consecutive, previously untreated patients with stage I, II A-B and IIIA Hodgkin's disease were treated with combined modality therapy including subtotal or...
Eighty-four consecutive, previously untreated patients with stage I, II A-B and IIIA Hodgkin's disease were treated with combined modality therapy including subtotal or total nodal irradiation, followed by three cycles of MOPP. MOPP was administered before radiotherapy in patients with systemic symptoms or with bulky disease. Seventy-six of 84 patients (90.5%) achieved complete remission, and 8 died from disease progression after a variable period of incomplete remission. Three of 76 (3.9%) relapsed, and 2 of them have been subsequently salvaged. Up to the present time, 70 patients are alive, without evidence of disease; 9 have died from Hodgkin's disease, 2 from acute non-lymphoblastic leukemia, and 3 from intercurrent causes. No death occurred from acute toxicity due to chemotherapy. Actuarial overall survival is 82.3% and freedom from relapse is 81.8% after 48 months' median observation (range: 12-111 months). No significant difference in survival and freedom from relapse has been observed with respect to age, sex, stage, presence or absence of unfavorable prognostic factors. The role of adjuvant chemotherapy and its use in a reduced number of cycles in early stage Hodgkin's disease are discussed.
Topics: Age Factors; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Evaluation Studies as Topic; Female; Hodgkin Disease; Humans; Lymphatic Metastasis; Male; Mechlorethamine; Prednisone; Procarbazine; Prognosis; Retrospective Studies; Sex Factors; Vincristine
PubMed: 6689093
DOI: 10.1177/030089168306900514