[Low-dose accelerated hyperfractionated radiotherapy for local control of chemoresistant Hodgkin's disease (a prospective randomized trial)].

The results are evaluated of the combined treatment of 154 patients with relapsed refractory Hodgkin's disease, which was conducted using standard dosage of conventional chemotherapy. Out of those, 117 with residual lesions were randomized to receive either focal radiotherapy (20-24 Gy) in accelerated hyperfractionation (1.3-1.5 Gy, twice a day, at 5-hr interval) or 38-40 Gy in standard fractionation. Local control persisted in 85-97% of irradiated sites (median follow-up of 24 months), irrespective of irradiation technique. TTD being lowered down to 20-24 Gy due to use of accelerated hyperfractionation, the frequency of late-onset radiation injuries of paramediastinal lung tissue was lower than in standard treatment, with a subsequently lower fraction of patients with stage II fibrosis.

Management of Hodgkin's disease patients with mediastinal adenopathy and pulmonary involvement (stage IIE).

Two hundred and fifty-five patients with Hodgkin's disease and with localized pulmonary involvement (Stage IIE) were retrospectively assessed for their response to different treatment programmes while considering the size of mediastinal lymph nodes and the extent of pulmonary disease (involvement of lung subsegment, segment or lobe). Five-year overall and disease-free survival rates in 255 patients were 89.6% and 72.3%, respectively. In patients with mediastinal index < 1/3 and lung segment and/or subsegment involvement, 5-year overall and disease-free survival rates were 96.6%. For patients with mediastinal index > 1/3 and similar lung involvement the corresponding values were, respectively, 88.6% and 73.5%; and for those with a lung lobe involvement the values were 76.4% and 56.7%, respectively. Patients were treated according to the following programmes: 1 combination chemotherapy cycle + radiotherapy (RT) + 4-5 combination chemotherapy cycles; 3 combination chemotherapy cycles + RT; 6 combination chemotherapy cycles + RT. The best results were obtained with the programme consisting of 1 combination chemotherapy cycle + lymphoid irradiation above the diaphragm and irradiation of the spleen to a total tumour dose of 40 Gy and irradiation of involved lung sites to a total tumour dose of 20 Gy + 4-5 combination chemotherapy cycles.

[The clinical significance of bone involvement in patients with primary lymphogranulomatosis]. / Klinicheskoe znachenie porazheniia kostei u pervichnykh bol'nykh limfogranulematozom.

A retrospective analysis of 2450 case histories of primary Hodgkin's disease established bone lesions incidence at 3.8%. They occurred in cases of general symptoms (6%) rather than otherwise (1.6%). Bone involvement came about chiefly via the blood flow pathway (59%), with several bones being involved in most cases. Dissemination through contact was less frequent 39%), the breast bone or vertebrae being involved relatively more often. Both radiation and polychemotherapy caused local healing effect which would lead to full recovery of bone structure in some cases. Therefore, combined (polychemotherapy + radiation) treatment should be recommended in cases of single lesions whereas treatment for multiple lesions may be limited to medication.

[The combined (polychemical and radiation) and drug treatment of lymphogranulomatosis patients with generalized lung involvement (stage IV)]. / Kombinirovannoe (polikhimio- i luchevoe) i lekarstvennoe lechenie bol'nykh limfogranulematozom s generalizovannym porazheniem legkikh (IV stadii).

The paper is concerned with analysis of the peculiarities of a course of disease and effectiveness of different therapeutic programs in 121 primary patients suffering from Hodgkin's disease with generalized lung lesion (true stage IV). The 5-year total and recurrence-free survival of patients after polychemoradiotherapy was 59.5 and 45.6%, respectively. Prognosis of disease in patient with generalized lung lesion is determined mainly by the development of a specific process in pulmonary tissue and, to a lesser degree, by spreading of disease via the lymphatic collectors. The authors have shown the appropriateness of combined therapy of this group of patients. Therapy includes cycles of polychemotherapy for achieving remission and radiotherapy including total irradiation of the affected lung for its consolidation.

[Pleural lesions in patients with Hodgkin's disease with pulmonary involvement]. / Porazhenie plevry u bol'nykh limfogranulematozom s vovlecheniem v protsess legkikh.

A retrospective study of 334 primary patients with Hodgkin's disease with the affected mediastinal lymph nodes and pulmonary tissue (stages IIE, IV) was carried out. Pleural affection was detected in 280 (88.8%) patients. Limited pleural affection resulting from contact dissemination from the enlarged lymph nodes was shown to make no effect on prognosis. Generalized involvement of the pleura was shown to deteriorate considerably a course of disease in patients with contact (localized) pulmonary involvement and to have no prognostic importance in disseminated involvement.

[Indices of external respiration in patients with Hodgkin's disease long after irradiation of the mediastinum]. / Pokazateli vneshnego dykhaniia u bol'nykh limfogranulematozom v otdalennye sroki posle oblucheniia sredosteniia.

The function of the respiratory organs using the results of ventilation, gas exchange and roentgenopneumopolygraphy, was analysed in 98 Hodgkin's disease patients in a state of a prolonged remission (5-12 yrs.) after radiation therapy of the mediastinum. Pulmonary ventilation disorders were revealed in 43.9% of the patients. The degree of ventilation disorders depended on the degree of expression of radiation fibrosis in the paramediastinal regions of the lungs. Usually there were no clinical signs of the revealed changes.

[Changes in the lungs in patients with lymphogranulomatosis, Stages I-II, following combination therapy]. / Izmeneniia v legkikh u bol'nykh limfogranulematozom I-II stadii posle kombinirovannogo lecheniia.

Early and late pulmonary changes in 140 patients with Hodgkin's disease, Stages I-II, following combined treatment (polychemo- and radiotherapy) are analysed. Radiation pulmonitis and local paramediastinal fibrosis occur less frequently and they are less noticeable in combined therapy as compared to similar changes developing after radiation therapy only. It can be due to the fact that a course of polychemotherapy at its first stage results in a considerable decrease of the mediastinal lymph nodes (up to their complete regression) thus making it possible to shape irradiation fields of smaller sizes and to decrease the volume of pulmonary tissue to be irradiated.

[Programs for the radiation and drug treatment of metastases of Ewing's sarcoma to the lungs in children]. / Programmy luchevogo i lekarstvennogo lecheniia metastazov sarkomy Iuinga v legkie u detei.

As a result of total-local irradiation of the lung combined with polychemotherapy in patients with solitary metastases to the lungs, a 3-year survival in children was 52.7 +/- 12.1%, after local irradiation of the lungs and chemotherapy 30 +/- 11.8% of the patients. Combined treatment was well tolerated by pediatric patients. The results of the study have shown that radiation therapy of metastases of Ewing's sarcoma to the lungs with simultaneous polychemotherapy does not disturb external respiratory function even in a later period, the clinical manifestations of lung radiation reactions were seldom observed.

[Early and late changes in the lungs following irradiation of the mediastinum (based on studies of patients with lymphogranulomatosis)]. / Rannie i pozdnie izmeneniia legkikh posle oblucheniia sredosteniia (po materialam issledovaniia bol'nykh limfogranulematozom).

In a group of 180 patients with Hodgkin's disease who received irradiation of the mediastinum, 23 (12.7%) developed shortly after that (up to 6 mos.) the signs of radiation pulmonitis, later on 171 (95%) local paramediastinal fibrosis. Radiation changes revealed were either subclinical or asymptomatic. The frequency of early radiation changes and the extent of local fibrosis depend on the volume of irradiated pulmonary tissue. The summary focal doses within the range of 31-45Gy are less important.