-
The New England Journal of Medicine Dec 2009
Comparative Study
Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Dacarbazine; Doxorubicin; Follow-Up Studies; Hodgkin Disease; Humans; Mechlorethamine; Prednisone; Procarbazine; Survival Analysis; Vinblastine; Vincristine
PubMed: 20007568
DOI: 10.1056/NEJMc0906731 -
Voprosy Onkologii 2009A computer database was created to take care of a wide range of protocols for combined treatment of Hodgkin's disease stage I-IV (n=1,573). Early-onset radiation-related...
A computer database was created to take care of a wide range of protocols for combined treatment of Hodgkin's disease stage I-IV (n=1,573). Early-onset radiation-related injuries (pneumonitis) and exposure of lung tissues to radiation were identified as the main risk factors for cardiopathology development. It is suggested that total focal dosage used after chemotherapy be reviewed since total dosage for the entire lymph collector in excess of 30 Gy might contribute to hazards of cardiopathology. However, a locally administered TTD ranging 36-44 Gy to deal with residual tumor offers best advantage in preventing local relapse. Nor does it increase the risk of future complications. Our approach might promote individualization of prognosis as far as cardiac complications involved in Hodgkin's lymphoma are concerned.
Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Female; Heart; Heart Diseases; Heart Neoplasms; Hodgkin Disease; Humans; Male; Mechlorethamine; Middle Aged; Multivariate Analysis; Neoplasm Staging; Pneumonia; Prednisone; Procarbazine; Prognosis; Radiotherapy Dosage; Radiotherapy, Adjuvant; Risk Assessment; Risk Factors; Survival Analysis; Vincristine
PubMed: 19947368
DOI: No ID Found -
International Journal of Radiation... Dec 2009To evaluate the roles of radiation dose, chemotherapy, and other factors in the etiology of stomach cancer in long-term survivors of testicular cancer or Hodgkin...
PURPOSE
To evaluate the roles of radiation dose, chemotherapy, and other factors in the etiology of stomach cancer in long-term survivors of testicular cancer or Hodgkin lymphoma.
METHODS AND MATERIALS
We conducted a cohort study in 5,142 survivors of testicular cancer or Hodgkin lymphoma treated in the Netherlands between 1965 and 1995. In a nested case-control study, detailed information on treatment, smoking, gastrointestinal diseases, and family history was collected for 42 patients with stomach cancer and 126 matched controls. For each subject, the mean radiation dose to the stomach was estimated. Relative risks (RRs) of stomach cancer and the radiation-related excess relative risk (ERR) per gray were calculated by conditional logistic regression analysis.
RESULTS
The risk of stomach cancer was 3.4-fold increased compared with the general population. The risk increased with increasing mean stomach dose (p for trend, <0.001), at an ERR of 0.84 per Gy (95% confidence interval [CI], 0.12-15.6). Mean stomach doses of more than 20 Gy were associated with a RR of 9.9 (95% CI, 3.2-31.2) compared with doses below 11 Gy. The risk was 1.8-fold (95% CI, 0.8-4.4) increased after chemotherapy and 5.4-fold (95% CI, 1.2-23.9) increased after high doses of procarbazine (>or=13,000 mg) vs. <10,000 mg. The RR of smoking more than 10 cigarettes per day vs. no smoking was 1.6 (95% CI, 0.6-4.2).
CONCLUSIONS
Stomach cancer risk is strongly radiation dose dependent. The role of chemotherapy, particularly of procarbazine and related agents, needs further study, because of the relatively small numbers of chemotherapy-treated subjects.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Case-Control Studies; Cohort Studies; Combined Modality Therapy; Dose-Response Relationship, Radiation; Female; Gastrointestinal Diseases; Hodgkin Disease; Humans; Male; Mechlorethamine; Middle Aged; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Netherlands; Prednisone; Procarbazine; Radiotherapy Dosage; Regression Analysis; Risk; Smoking; Stomach Neoplasms; Survivors; Testicular Neoplasms; Vincristine; Young Adult
PubMed: 19931732
DOI: 10.1016/j.ijrobp.2009.01.073 -
Journal of Veterinary Internal Medicine 2009Dogs with multicentric lymphoma are treated with various cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy protocols with variable...
BACKGROUND
Dogs with multicentric lymphoma are treated with various cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy protocols with variable success.
OBJECTIVES
To describe the progression-free survival (PFS) time and overall survival time (OST) of dogs with T-cell lymphoma or hypercalcemic lymphoma treated with L-asparaginase and mechlorethamine, vincristine, prednisone, procarbazine (MOPP).
ANIMALS
Fifty dogs with T-cell lymphoma, hypercalcemic lymphoma, or both treated at 3 referral veterinary hospitals.
METHODS
Retrospective study. Case were selected based on histologic or cytologic diagnosis of lymphoma; presence of the T-cell phenotype, presence of hypercalcemia or both; and absence of previous chemotherapy. The T-cell phenotype was determined by flow cytometry, immunocytochemistry, immunohistochemistry, or polymerase chain reaction of antigen receptor rearrangement.
RESULTS
The overall response rate was 98% (78% complete response, 20% partial response). The median PFS for the entire study population was 189 days with 25% PFS at 939 days. The median OST for the entire study population was 270 days with 25% surviving 939 days. Twenty percent of the dogs required hospitalization for treatment related complications.
CONCLUSIONS AND CLINICAL IMPORTANCE
L-Asp/MOPP chemotherapy might result in longer PFS and OST for dogs with multicentric T-cell lymphoma, dogs with hypercalcemic lymphoma or both, than achieved with CHOP.
Topics: Animals; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Dog Diseases; Dogs; Female; Lymphoma; Male; Mechlorethamine; Prednisone; Procarbazine; Retrospective Studies; Vincristine
PubMed: 19645842
DOI: 10.1111/j.1939-1676.2009.0289.x -
Anticancer Research Feb 2009The combination of mediastinal radiotherapy (RT) and polychemotherapy (CT) regimens can produce late toxic pulmonary and cardiac effects which often remain at the...
The combination of mediastinal radiotherapy (RT) and polychemotherapy (CT) regimens can produce late toxic pulmonary and cardiac effects which often remain at the subclinical level. The aim of the present study was to investigate the cardiopulmonary response to exercise in this kind of patient. Therefore, 126 patients suffering from Hodgkin's disease were investigated after a follow-up of at least 5 years from the completion of the combined treatment. Sixty-two patients had been submitted to ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)-RT, 40 to ABVD-MOPP (mechloretamine, vincristine, procarbazine, prednisone)-RT and 24 to VEBEP (vincristine, epidoxorubicin, bleomycin, cyclophosphamide, etoposide, prednisone)-RT. The patients were divided into three groups on the basis of respiratory function: group 1 (67 patients), normal spirometry and lung transfer function for carbon monoxide (DLCO); group 2 (52 patients), normal spirometry and DLCO less than 80% of predicted; and group 3 (7 patients), total lung capacity and DLCO less than 80% of predicted. The patients were submitted to respiratory function evaluation and 2D-echocardiography before exercise, and to the determination of cardiac output by the acetylene rebreathing method before and during symptom-limited exercise on a cycloergometer using an incremental protocol. The patients of group 3 and to a lesser extent the patients of group 2 showed, in comparison to patients of group 1, a lower tolerance to exercise, a lower oxygen consumption, a higher respiratory rate, a lower O2 pulse and a lower cardiac output per oxygen uptake. These data indicated an abnormal exercise physiology in the patients with persistent pulmonary impairment, especially when the reduction of DLCO was associated with a decrease of total lung capacity. The lower exercise capacity seems to be due to a combination of decreased cardiac performance and an impairment of gas diffusion capacity.
Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cardiovascular Diseases; Combined Modality Therapy; Cyclophosphamide; Dacarbazine; Doxorubicin; Epirubicin; Etoposide; Exercise; Female; Hodgkin Disease; Humans; Lung Diseases; Male; Mechlorethamine; Middle Aged; Prednisone; Procarbazine; Radiation Injuries; Vinblastine; Vincristine; Young Adult
PubMed: 19331235
DOI: No ID Found -
Voprosy Onkologii 2008The end results of treatment of Hodgkin's disease are evaluated. Since survival rates for patients receiving risk-adapted programs (DAL-Hd, SPBLKH-05) were higher than... (Comparative Study)
Comparative Study
The end results of treatment of Hodgkin's disease are evaluated. Since survival rates for patients receiving risk-adapted programs (DAL-Hd, SPBLKH-05) were higher than in control (MOPP), relevant protocols using lower drug dosage should be recommended in groups of favorable and intermediate risk.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Child; Child, Preschool; Disease-Free Survival; Female; Hodgkin Disease; Humans; Male; Mechlorethamine; Prednisone; Procarbazine; Radiotherapy, Adjuvant; Remission Induction; Risk Assessment; Risk Factors; Survival Analysis; Treatment Outcome; Vincristine
PubMed: 19241857
DOI: No ID Found -
Zhonghua Zhong Liu Za Zhi [Chinese... Aug 2008To compare the efficacy of chemotherapy alone, radiotherapy alone and combined-modality therapy in the treatment for early-stage Hodgkin's lymphoma (HL). (Comparative Study)
Comparative Study
OBJECTIVE
To compare the efficacy of chemotherapy alone, radiotherapy alone and combined-modality therapy in the treatment for early-stage Hodgkin's lymphoma (HL).
METHODS
From 1999 to 2002, totally 150 patients with stage I or II HL were treated in our hospital. They were stratified into several groups based on initial treatment strategy: chemotherapy alone (CT group, n = 22), radiotherapy alone (RT group, n = 18), combined-modality therapy (CMT group, n = 109) and surgical resection (SR group, n = 1). Chemotherapy regimens were mainly ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) and MOPP (mechlorethamine, vincristine, procarbazine and prednisone). Radiotherapy modes included involved field radiotherapy (IFRT), extended field radiotherapy (EFRT) and sub-total nodal irradiation (STNI).
RESULTS
The pathological types included nodular sclerosis (NS, n = 84), mixed-cellularity (MC, n = 39), lymphocyte-predominant (LP, n = 23), lymphocyte-depleted (LD, n = 3) and nodular lymphocyte predominant Hodgkin's disease (NLPHD, n = 1). Of those, 72 were evaluble in terms of prognostic factors. No poor prognostic factor was found in 36.1% or 29.2% of the patients according to EORTC or GHSG criteria, respectively. There were 33 patients with complete response (CR), 109 with partial response (PR), 5 with stable disease (SD) and 3 with progressive disease (PD) after initial therapy. The median follow-up period was 71.5 months. The overall 7-yr survival rate was 89.3%, and treatment failure rate at 6 years was 18.8%. The response rate of CMT group was superior to that of CT group, and the patients with nodular sclerosis or mixed-cellularity type had significantly lower risk of treatment failure (P = 0.009 and 0.019, respectively). The multivariate analysis revealed that the treatment strategies affected the prognosis significantly. The risk of failure of chemotherapy alone was 2.52 times higher than that of combined-modality therapy (P = 0.004). No predictive factor affecting OS was identified by either univariate or multivariate analysis. The patients in CMT group suffered more adverse effects than those in either CT or RT groups, which mainly consisted of leucopenia, alopecia and gastrointestinal symptoms.
CONCLUSION
Combined-modality therapy is more effective than chemotherapy alone or radiotherapy alone in the treatment for early stage Hodgkin's lymphoma. Though its acute adverse effects are more severe than that of chemotherapy or radiotherapy alone, it may reduce the risk of treatment failure.
Topics: Adolescent; Adult; Aged; Alopecia; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Child; Child, Preschool; Combined Modality Therapy; Dacarbazine; Doxorubicin; Female; Follow-Up Studies; Hodgkin Disease; Humans; Leukopenia; Male; Mechlorethamine; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prednisone; Procarbazine; Proportional Hazards Models; Radiotherapy; Remission Induction; Retrospective Studies; Survival Rate; Vinblastine; Vincristine; Young Adult
PubMed: 19102946
DOI: No ID Found -
International Journal of Radiation... Dec 2008The improved survival rates among patients with Hodgkin's lymphoma over the past few decades have come with increased incidence of second malignancies. One of the major... (Review)
Review
The improved survival rates among patients with Hodgkin's lymphoma over the past few decades have come with increased incidence of second malignancies. One of the major concerns among female survivors is the significantly elevated risk of breast cancer that appears with extended follow-up. In this review, we include the published literature regarding the risk of breast cancer after irradiation for Hodgkin's lymphoma. We also present the possible long-term surveillance strategies and the optimal time to start screening these women. This could potentially help in early detection of secondary breast cancers and consequently improve outcomes. Furthermore, because of prior radiotherapy, the management of the breast cancer among this unique population has been controversial. We discuss the characteristics of breast cancer that occurs after Hodgkin's lymphoma and also treatment options that could be implemented.
Topics: Adolescent; Adult; Age of Onset; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Breast Neoplasms; Child; Dacarbazine; Doxorubicin; Female; Hodgkin Disease; Humans; Mechlorethamine; Neoplasm Staging; Prednisone; Procarbazine; Radionuclide Imaging; Radiotherapy; Risk Factors; Splenectomy; Vinblastine; Vincristine; Young Adult
PubMed: 19028269
DOI: 10.1016/j.ijrobp.2008.07.060 -
Pediatric Blood & Cancer Nov 2008
Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Hodgkin Disease; Humans; Mechlorethamine; Prednisone; Procarbazine; Prognosis; Radiotherapy; Survival Analysis; Vincristine
PubMed: 18668513
DOI: 10.1002/pbc.21649 -
Voprosy Onkologii 2008Retrospective investigation was carried out of clinical course and effectiveness of therapy in 31 patients with primary hepatic involvement in Hodgkin's disease and 63...
Retrospective investigation was carried out of clinical course and effectiveness of therapy in 31 patients with primary hepatic involvement in Hodgkin's disease and 63 cases of hepatic lesions relating to dissemination of relapsing tumor. Clinical diagnosis of hepatic involvement ought to be made using at least two procedures, preferably liver scanning and computed tomography of the abdominal cavity. Special attention should be given to most likely cases of specific lesions of liver who had previously presented with intoxication symptoms and spleen and/or subphrenic lymph node involvement. Dissemination-related hepatic lesions were among the most frequent (78%) in patients with primary tumor while focal and diffuse liver involvement was limited to 71% of cases of dissemination of relapsing tumor. MOPP, ABVD and BEACOPP regimes should be given preference in dealing with primary Hodgkin's disease. The latter procedure should predominate in cases of initial extended involvement or as second-line chemotherapy designed to defeat drug resistance and improve end results.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dacarbazine; Doxorubicin; Etoposide; Female; Hodgkin Disease; Humans; Liver Neoplasms; Male; Mechlorethamine; Middle Aged; Prednisone; Procarbazine; Prognosis; Radionuclide Imaging; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Vinblastine; Vincristine
PubMed: 18522169
DOI: No ID Found