ABSTRACT
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.
Subject(s)
Heart Diseases/etiology , Heart/radiation effects , Hodgkin Disease/radiotherapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Female , Heart Diseases/mortality , Heart Neoplasms/secondary , Hodgkin Disease/drug therapy , Hodgkin Disease/pathology , Humans , Male , Mechlorethamine/administration & dosage , Middle Aged , Multivariate Analysis , Neoplasm Staging , Pneumonia/etiology , Prednisone/administration & dosage , Procarbazine/administration & dosage , Prognosis , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , Risk Assessment , Risk Factors , Survival Analysis , Vincristine/administration & dosageABSTRACT
A prognostic model for Hodgkin's disease was worked out using the data on disease-free survival among patients receiving 4-8 courses of COOP(MOPP)/ABVD plus (sub)total irradiation. Patients with stage I-II Hodgkin's disease (less then 4 lesions) without large involved mediastinal masses, intoxication symptoms and focal splenic involvement were referred to the favorable prognosis group. The poor prognosis group featured stage III(2)-IV tumor as well as large masses of involved mediastinal tissue, focal splenic involvement at any stage plus 7 or more lesions. An assessment of tumor advancement across lesions is more significant for radiotherapy planning rather than that of organ involvement. It is reasonable to distinguish two substages--III(1) and III(2). Our model was compared with GHSG and it was suggested that ways be found to use both of them in prognosing of disease outcome.
Subject(s)
Hodgkin Disease/diagnosis , Models, Statistical , Hodgkin Disease/pathology , Humans , Neoplasm Staging , PrognosisABSTRACT
Data are presented on our 5-year experience with combination chemotherapy of stage II-IV Hodgkin's disease (110), the unfavorable prognosis group, using a novel regimen of chemotherapy--CEA/ABVD (belustin, etoposide, doxorubicin, bleomycin, vinblastine, dacarbazine). Complete remission after 4 courses of CEA/ABVD chemotherapy was reported in 31.8%, unconfirmed complete remission--45.5%, objective effect--100% and an 80% regression of tumor mass--93.2%. No chemo-resistant forms were identified. Five-year actuarial relapse-free survival was 96.4%; overall 5-year survival--97.7%. Death from complications recorded during medication period occurred in 2.3% (1 out of 44), recurrence--2.3% (1 out of 44). Recurrence-free survival rose by 25% (p < 0.05) while overall survival--by 20% (p = 0.04 in year 3), as compared with COOP(MOPP)/ABVD (179 patients with poor prognosis). Our regimen opens up new vistas in managing Hodgkin's disease.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/drug therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bleomycin/administration & dosage , Carboplatin/administration & dosage , Dacarbazine/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , Drug Administration Schedule , Etoposide/administration & dosage , Female , Follow-Up Studies , Hodgkin Disease/pathology , Humans , Male , Middle Aged , Neoplasm Staging , Prognosis , Survival Analysis , Treatment Outcome , Vinblastine/administration & dosageABSTRACT
Data on 668 patients receiving 4-8 cycles of chemotherapy were used to suggest the following approach to complex therapy of Hodgkin's disease: devise a simplified model for Hodgkin's disease, develop a new modality of chemotherapy, demonstrate feasibility of only four chemotherapy cycles in the poor prognosis group, partial response as the ultimate goal of chemotherapy as well as the importance of subtotal dosage under 26-36 Gy sufficient for irradiation of the entire lymphatic collector. Said measures will, in their totality, offer fresh opportunities in treatment of Hodgkin's disease.
Subject(s)
Hodgkin Disease/drug therapy , Hodgkin Disease/radiotherapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Feasibility Studies , Female , Humans , Male , Middle Aged , Prognosis , Radiotherapy, Adjuvant , Treatment OutcomeABSTRACT
The efficacy of different combinations of radiotherapy and mastectomy after Madden was compared in 411 patients with stage II breast tumors. The least likelihood of local reccurence (4.5 +/- 1.3%) was recorded after single exposure before mastectomy and with/without adjuvant irradiation of the regional lymphatics (group I); it appeared 1.5 times as high (7.0 +/- 2.1%) after mastectomy + postoperative irradiation (group II) while the highest frequency (14.8 +/- 5.4%) was registered after surgery alone (group III). Relapse-free 10-year survival was observed in 63.5 +/- 4.7 (group I), 77.4 +/- 4.6 (group II) and 46.2 +/- % (group III), respectively, the difference between group I and II being significant. Therefore, postoperative radiotherapy in conjunction with mastectomy (Madden) should be recommended for stage II breast carcinoma when the breast cannot be salvaged.
