ABSTRACT
Radiation therapy has evolved from extended-field radiation therapy (EFRT) to involved-field radiation therapy (IFRT), reducing toxicity while maintaining high cure rates. Recent publications recommend a further reduction to involved-nodal radiation therapy (INRT); however, this has not been clinically validated. The need for irradiation or optimal radiation volume after chemotherapy are not defined. The treatment results of 296 Hodgkin's disease patients receiving ABVD or BEACOPP-21 chemotherapy with consequent EFRT demonstrate CR/PR > or = 80% and 99% local disease control rate. Beam therapy with EFRT is possible to use if dose levels don't exceed 30 Gy. Higher doses demands reduction of volume of radiating target. In our opinion the optimum program of beam therapy involves 2 stages with maximal possible dose level EFRT followed by additional INRT. Those approaches offer perspectives for Hodgkin's disease treatment.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/drug therapy , Hodgkin Disease/radiotherapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Bleomycin/administration & dosage , Cyclophosphamide/administration & dosage , Dacarbazine/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , Etoposide/administration & dosage , Female , Hodgkin Disease/mortality , Humans , Male , Middle Aged , Prednisone/administration & dosage , Procarbazine/administration & dosage , Radiotherapy Dosage , Radiotherapy, Adjuvant/methods , Treatment Outcome , Vinblastine/administration & dosage , Vincristine/administration & dosageABSTRACT
Based on the results of combined treatment with inclusion of ABVD and BEACOPP-21 chemotherapy regimens the basic principles of therapy depending on the nodal relaps criterium were developed. The most rational approach to treatment results evaluation concerns the lesions with the least response to chemotherapy. The groups of "adequate" and "inadequate" response to chemotherapy should be formed. The initial lesion localisation doesn't play an important part in the modern chemotherapy settings and should not be concerned while choosing tactics of radiation therapy. The method described should interest oncologists and radiologists involved in the treatment of Hodgkin lymphoma.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/drug therapy , Hodgkin Disease/radiotherapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Bleomycin/administration & dosage , Cyclophosphamide/administration & dosage , Dacarbazine/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , Etoposide/administration & dosage , Female , Hodgkin Disease/mortality , Hodgkin Disease/pathology , Humans , Male , Middle Aged , Prednisone/administration & dosage , Procarbazine/administration & dosage , Radiotherapy Dosage , Radiotherapy, Adjuvant/methods , Treatment Outcome , Vinblastine/administration & dosage , Vincristine/administration & dosageABSTRACT
Based on the treatment results of 300 Hodgkin lymphoma patients the authors formulated the basic approaches for radiation treatment in ABVD and BEACOPP-21 chemotherapy regimens recipients. In patients with complete response to chemotherapy any dose regimen (26 to 44 Gr) leads to 100% local disease control. In patients with major response to chemotherapy (PR> or =80%) the 36 Gr total focal dose allows an adequate local control, more intensive local control doesn't yield better results. In patients with PR 0-79% the implication of total focal doses less than 40 Gr leads to statistically significant increase of nodal relapse rate. These treatment approaches may be implied by specialists conducting chemotherapy and radiation therapy in Hodgkin lymphoma patients.
