Comparative assessment of radiation therapy-induced vasculitis using [18F]FDG-PET/CT in patients with non-small cell lung cancer treated with proton versus photon radiotherapy.

PURPOSE: To assess radiation therapy (RT)-induced vasculitis in patients with non-small cell lung cancer (NSCLC) by examining changes in the uptake of 18F-fluoro-D-deoxyglucose ([18F]FDG) by positron emission tomography/computed tomography (PET/CT) images of the ascending aorta (AA), descending aorta (DA), and aortic arch (AoA) before and after proton and photon RT. METHOD: Thirty-five consecutive locally advanced NSCLC patients were definitively treated with proton (n = 27) or photon (n = 8) RT and concurrent chemotherapy. The patients were prospectively enrolled to undergo [18F]FDG-PET/CT imaging before and 3 months after RT. An adaptive contrast-oriented thresholding algorithm was applied to generate mean standardized uptake values (SUVmean) for regions of interest (ROIs) 3 mm outside and 3 mm inside the outer perimeter of the AA, DA, and AoA. These ROIs were employed to exclusively select the aortic wall and remove the influence of blood pool activity. SUVmeans before and after RT were compared using two-tailed paired t-tests. RESULTS: RT treatments were associated with increased SUVmeans in the AA, DA, and AoA-1.9%, 0.3%, and 1.3% for proton and 15.8%, 9.5%, and 15.5% for photon, respectively. There was a statistically significant difference in the ∆SUVmean (post-RT SUVmean - pre-RT SUVmean) in patients treated with photon RT when compared to ∆SUVmean in patients treated with proton RT in the AA (p = 0.043) and AoA (p = 0.015). There was an average increase in SUVmean that was related to dose for photon patients (across structures), but that was not seen for proton patients, although the increase was not statistically significant. CONCLUSION: Our results suggest that patients treated with photon RT for NSCLC may exhibit significantly more RT-induced inflammation (measured as ∆SUVmean) in the AA and AoA when compared to patients who received proton RT. Knowledge gained from further analyses in larger cohorts could aid in treatment planning and help prevent the significant morbidity and mortality associated with RT-induced vascular complications. TRIAL REGISTRATION: NCT02135679.

Study of residual oil in Bay Jimmy sediment 5 years after the Deepwater Horizon oil spill: Persistence of sediment retained oil hydrocarbons and effect of dispersants on desorption.

The 2010 Deepwater Horizon (DwH) oil spill contaminated ~1,773km of the Gulf of Mexico shorelines. Yet, few field data are available on the long-term fate and persistency of sediment-retained oil. While an unprecedented amount of oil dispersants was applied, the effects of oil dispersants on desorption of field aged oil remain unknown. This study aimed to investigate the abundance, distributions and physico-chemical availability of the oil retained in Bay Jimmy sediment, Louisiana, five years after the DwH oil spill, and to determine the effects of two model oil dispersants on the desorption potential of the residual oil. Total petroleum hydrocarbons (TPHs), n-alkanes and polycyclic aromatic hydrocarbons (PAHs) in the sediment were analyzed and compared with those in the crude oil and the pre-DwH levels, and batch desorption kinetic tests were carried out to quantify the dispersant effects on the desorption rate and extent. The biomarker hopanes profile and diagnostic ratio were analyzed, which confirmed the origin and persistence of the sediment-retained oil. After five-year natural weathering, the oil level in the sediment remained orders of magnitude higher than the pre-spill level. Nearly all low-molecular-weight n-alkanes and 2-ring PAHs had been degraded. Oil dispersants, SPC 1000 and Corexit EC9500A, were able to enhance solubilization of the sediment-retained oil upon resuspension of the sediment. Successive desorption experiments indicated that 71.6% of TPHs, 74.8% of n-alkanes, and 91.9% of PAHs in the sediment remained highly stable and hardly desorbable by seawater; yet, addition of 18mg/L of SPC 1000 enhanced the desorption and lowered these fractions to 57.3%, 68.1%, and 81.4%, respectively. The findings are important for understanding the natural weathering rate and persistence of oil residual and the effects of dispersants on the physical and biological availabilities of aged oil in coastal sediments.

Effects of oil dispersants on photodegradation of parent and alkylated anthracene in seawater.

This study investigated effects of three model oil dispersants on photodegradation of two model PAHs (anthracene and 9,10-dimethyanthracene (9,10-DMA)) under simulated sunlight. All three dispersants, i.e. Corexit EC9500A, Corexit EC9527A and SPC 1000, promoted the photolysis rate of 9,10-DMA, following the order of Corexit EC9500A > Corexit EC9527A > SPC 1000. The photodegradation rate was well interpreted by a two-stage, first-order kinetic law with a faster initial photolysis rate in the presence of the dispersants. Span 80, Tween 85 and kerosene were found as the key dispersant components, of which Span 80 and Tween 85 promoted the photodegradation by boosting absorbance of solar irradiation while kerosene by dispersing more PAHs in the upper layer of the water column. Dissolved oxygen (DO) inhibited photolysis of anthracene regardless of dispersant resulting from quenching the excited states of the PAH, while DO facilitated photolysis of 9,10-DMA due to the formation singlet oxygen (1O2) radicals in the presence of oil dispersants. The other ROS, i.e. •O2- and •OH, played a negligible role on the photodegradation of anthracene and 9,10-DMA. Fluorescence analysis showed that more anthracene was associated with dispersant than 9,10-DMA, which favored the direct transfer of energy to anthracene, while energy is more likely transferred to oxygen to form 1O2 in the case of 9,10-DMA. Direct photolysis dominated the photodegradation of anthracene and 9,10-DMA. Both direct ionization of anthracene and the electron transfer from excited 9,10-DMA to oxygen can lead to formation of the corresponding PAH radical cations. Overall, the oil dispersants accelerated the photolysis rates of the PAHs without altering the degradation pathway. The findings are useful for understanding photochemical weathering of dispersed oil components in the environment.

Effects of oil dispersants on settling of marine sediment particles and particle-facilitated distribution and transport of oil components.

This work investigated effects of three model oil dispersants (Corexit EC9527A, Corexit EC9500A and SPC1000) on settling of fine sediment particles and particle-facilitated distribution and transport of oil components in sediment-seawater systems. All three dispersants enhanced settling of sediment particles. The nonionic surfactants (Tween 80 and Tween 85) play key roles in promoting particle aggregation. Yet, the effects varied with environmental factors (pH, salinity, DOM, and temperature). Strongest dispersant effect was observed at neutral or alkaline pH and in salinity range of 0-3.5wt%. The presence of water accommodated oil and dispersed oil accelerated settling of the particles. Total petroleum hydrocarbons in the sediment phase were increased from 6.9% to 90.1% in the presence of Corexit EC9527A, and from 11.4% to 86.7% for PAHs. The information is useful for understanding roles of oil dispersants in formation of oil-sediment aggregates and in sediment-facilitated transport of oil and PAHs in marine eco-systems.

Mechanistic investigation into sunlight-facilitated photodegradation of pyrene in seawater with oil dispersants.

This study investigated the effects of 3 model oil dispersants (Corexit EC9500A, Corexit EC9527A and SPC 1000) on photodegradation of pyrene under simulated sunlight. Both Corexit dispersants enhanced photodegradation of pyrene, while SPC1000 slightly inhibited the reaction. Span 80 and Tween 85 were the key ingredients causing the effects, though the underlying mechanisms differed. Span 80 enriches pyrene in the upper layer of water column, whereas Tween 85 induces a photosensitization process. Two reactive oxygen species, 1O2 and O2-, were found responsible for pyrene photodegradation, though the presence of EC9500A suppressed the 1O2 pathway. In terms of photodegradation products, EC9500A enhanced generation of polyaromatic intermediates, i.e., phenaleno[1,9-cd][1,2]dioxine, 1-hydroxypyrene, and 1,8-pyrenequinone, but did not alter the classical photodegradation pathway. The Corexit dispersants were more prone to photochemical decomposition, with multiple by-products detected. The information aids in our understanding of the effects of dispersants on photochemical weathering of oil compositions.

A surface tension based method for measuring oil dispersant concentration in seawater.

This work developed a new method to determine concentration of Corexit EC9500A, and likely other oil dispersants, in seawater. Based on the principle that oil dispersants decrease surface tension, a linear correlation was established between the dispersant concentration and surface tension. Thus, the dispersant concentration can be determined by measuring surface tension. The method can accurately analyze Corexit EC9500A in the concentration range of 0.5-23.5mg/L. Minor changes in solution salinity (<0.3%), pH (7.9-9.0), and dissolved organic matter (<2.0mg/L as TOC) had negligible effects on the measurements. Moreover, effects of extracts from marine sediments were negligible, and thus, the method may be directly applied to seawater-sediment systems. The method accuracy was confirmed by comparing with direct TOC analysis. This simple, fast, economical method offers a convenient analytical tool for quantifying complex oil dispersants in water/seawater, which has been desired by the oil spill research community and industries.

Dispersion, sorption and photodegradation of petroleum hydrocarbons in dispersant-seawater-sediment systems.

This work examined effects of model oil dispersants on dispersion, sorption and photodegradation of petroleum hydrocarbons in simulated marine systems. Three dispersants (Corexit 9500A, Corexit 9527A and SPC 1000) were used to prepare dispersed water accommodated oil (DWAO). While higher doses of dispersants dispersed more n-alkanes and PAHs, Corexit 9500A preferentially dispersed C11-C20 n-alkanes, whereas Corexit 9527A was more favorable for smaller alkanes (C10-C16), and SPC 1000 for C12-C28 n-alkanes. Sorption of petroleum hydrocarbons on sediment was proportional to TPH types/fractions in the DWAOs. Addition of 18mg/L of Corexit 9500A increased sediment uptake of 2-3 ring PAHs, while higher dispersant doses reduced the uptake, due to micelle-enhanced solubilization effects. Both dispersed n-alkanes and PAHs were susceptible to photodegradation under simulated sunlight. For PAHs, both photodegradation and photo-facilitated alkylation were concurrently taking place. The information can facilitate sounder assessment of fate and distribution of dispersed oil hydrocarbons in marine systems.

Effects of oil dispersants on photodegradation of pyrene in marine water.

This work investigated effects of a popular oil dispersant (Corexit EC9500A) on UV- or sunlight-mediated photodegradation of pyrene (a model polycyclic aromatic hydrocarbon) in seawater. The presence of 18 and 180mg/L of the dispersant increased the first-order photodegradation rate by 5.5% and 16.7%, respectively, and reduced or ceased pyrene volatilization. By combining individual first-order rate laws for volatilization and photodegradation, we proposed an integrated kinetic model that can adequately predict the overall dissipation of pyrene from seawater. Mechanistic studies indicated that superoxide radicals played a predominant role in pyrene photodegradation, and the dispersant enhanced formation of superoxide radicals. 1-Hydroxypyrene was the main intermediate regardless of the dispersant, suggesting that electrons were transferred from excited pyrene to oxygen. In the presence of 18mg/L of the dispersant, the photodegradation rate increased with increasing ionic strength and temperature, but decreased with increasing HA concentration, and remained independent of solution pH. The results are important in understanding roles of oil dispersants on environmental fate of persistent oil components in natural and engineered systems.

Effects of oil dispersant on solubilization, sorption and desorption of polycyclic aromatic hydrocarbons in sediment-seawater systems.

This work investigated effects of a prototype oil dispersant on solubilization, sorption and desorption of three model PAHs in sediment-seawater systems. Increasing dispersant dosage linearly enhanced solubility for all PAHs. Conversely, the dispersant enhanced the sediment uptake of the PAHs, and induced significant desorption hysteresis. Such contrasting effects (adsolubilization vs. solubilization) of dispersant were found dependent of the dispersant concentration and PAH hydrophobicity. The dual-mode models adequately simulated the sorption kinetics and isotherms, and quantified dispersant-enhanced PAH uptake. Sorption of naphthalene and 1-methylnaphthalene by sediment positively correlated with uptake of the dispersant, while sorption of pyrene dropped sharply when the dispersant exceeded its critical micelle concentration (CMC). The deepwater conditions diminished the dispersant effects on solubilization, but enhanced uptake of the PAHs, albeit sorption of the dispersant was lowered. The information may aid in understanding roles of dispersants on distribution, fate and transport of petroleum PAHs in marine systems.

Effects of oil and dispersant on formation of marine oil snow and transport of oil hydrocarbons.

This work explored the formation mechanism of marine oil snow (MOS) and the associated transport of oil hydrocarbons in the presence of a stereotype oil dispersant, Corexit EC9500A. Roller table experiments were carried out to simulate natural marine processes that lead to formation of marine snow. We found that both oil and the dispersant greatly promoted the formation of MOS, and MOS flocs as large as 1.6-2.1 mm (mean diameter) were developed within 3-6 days. Natural suspended solids and indigenous microorganisms play critical roles in the MOS formation. The addition of oil and the dispersant greatly enhanced the bacterial growth and extracellular polymeric substance (EPS) content, resulting in increased flocculation and formation of MOS. The dispersant not only enhanced dissolution of n-alkanes (C9-C40) from oil slicks into the aqueous phase, but facilitated sorption of more oil components onto MOS. The incorporation of oil droplets in MOS resulted in a two-way (rising and sinking) transport of the MOS particles. More lower-molecular-weight (LMW) n-alkanes (C9-C18) were partitioned in MOS than in the aqueous phase in the presence of the dispersant. The information can aid in our understanding of dispersant effects on MOS formation and oil transport following an oil spill event.

A review of oil, dispersed oil and sediment interactions in the aquatic environment: influence on the fate, transport and remediation of oil spills.

The 2010 Deepwater Horizon oil spill has spurred significant amounts of researches on fate, transport, and environmental impacts of oil and oil dispersants. This review critically summarizes what is understood to date about the interactions between oil, oil dispersants and sediments, their roles in developing oil spill countermeasures, and how these interactions may change in deepwater environments. Effects of controlling parameters, such as sediment particle size and concentration, organic matter content, oil properties, and salinity on oil-sediment interactions are described in detail. Special attention is placed to the application and effects of oil dispersants on the rate and extent of the interactions between oil and sediment or suspended particulate materials. Various analytical methods are discussed for characterization of oil-sediment interactions. Current knowledge gaps are identified and further research needs are proposed to facilitate sounder assessment of fate and impacts of oil spills in the marine environment.

Effects of oil dispersant and oil on sorption and desorption of phenanthrene with Gulf Coast marine sediments.

Effects of a model oil dispersant (Corexit EC9500A) on sorption/desorption of phenanthrene were investigated with two marine sediments. Kinetic data revealed that the presence of the dispersant at 18 mg/L enhanced phenanthrene uptake by up to 7%, whereas the same dispersant during desorption reduced phenanthrene desorption by up to 5%. Sorption isotherms confirmed that at dispersant concentrations of 18 and 180 mg/L, phenanthrene uptake progressively increased for both sediments. Furthermore, the presence of the dispersant during desorption induced remarkable sorption hysteresis. The effects were attributed to added phenanthrene affinity and capacity due to sorption of the dispersant on the sediments. Dual-mode models adequately simulated sorption isotherms and kinetic data in the presence of the dispersant. Water accommodated oil (WAO) and dispersant-enhanced WAO increased phenanthrene sorption by up to 22%. This information is important for understanding roles of oil dispersants on the distribution and transport of petroleum PAHs in seawater-sediments.

Endocrine disrupting chemicals in New Orleans surface waters and Mississippi Sound sediments.

Endocrine disrupting compounds (EDCs), represented by steroid hormones, organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and bisphenol A have been determined in four sediment cores from the Gulf of Mexico, from New Orleans surface water (Lake Pontchartrain and Mississippi River), and from the influent and effluent of a New Orleans municipal sewage treatment plant. During the five-month monitoring of selected EDCs in the Mississippi River (MR) and Lake Pontchartrain (LP) in 2008, 21 of 29 OCPs in MR and 17 of 29 OCPs in LP were detected; bisphenol A was detected in all of the samples. Steroid hormones (estrone, 17ß-estradiol and 17α-ethinylestradiol) were detected occasionally. Total EDC (OCPs + PCBs + steroid hormones + bisphenol A) concentrations in the two surface water samples were found to vary from 148 to 1112 ng L(-1). Strong correlation of the distribution of total OCPs, total PCBs and total EDCs between solid and water phases was found in LP, while moderate or no correlation existed in MR. OCPs, PCBs, steroid hormones, and bisphenol A were all detected in the ocean sediments, and total EDCs were measured in the range of 77 to 1796 ng g(-1) dry sediment weight. The EDCs were also found in untreated and treated municipal sewage samples with a removal efficiency of 83% for OCPs but no removal efficiency for 17α-ethinylestradiol.

A randomized placebo-controlled study of tamoxifen after adjuvant chemotherapy in premenopausal women with early breast cancer (National Cancer Institute of Canada--Clinical Trials Group Trial, MA.12).

BACKGROUND: In the early 1990s, the role of adjuvant tamoxifen in premenopausal women with early breast cancer (EBC) was not established. Similarly, optimum timing relative to adjuvant chemotherapy and efficacy of tamoxifen in hormone receptor-negative tumors were unclear. PATIENTS AND METHODS: Premenopausal women with EBC, any hormone receptor status, after surgery received standard adjuvant chemotherapy [doxorubicin (adriamycin)/cyclophosphamide, cyclophosphamide/methotrexate/5-fluorouracil, or cyclophosphamide/epirubicin/5-fluorouracil] followed by randomization to tamoxifen or placebo for 5 years. Outcomes were overall survival (OS), disease-free survival (DFS), toxicity, and compliance with therapy. RESULTS: Median follow-up for 672 women was 9.7 years. Multivariate analysis showed improved DFS [78.2% versus 71.3% at 5 years; hazard ratio (HR) 0.77; P = 0.056] and a trend for improved OS (86.6% versus 82.1% at 5 years; HR 0.78; P = 0.12). There was no evidence of greater benefit for the receptor-positive subgroup. Compliance with treatment was suboptimal in both arms, with 103 (31%) women on tamoxifen and 70 (21%) on placebo-stopping therapy early because of toxicity, refusal, or other choices. CONCLUSIONS: Adjuvant tamoxifen, given after chemotherapy to premenopausal women with EBC, improved 5-year DFS. Poor compliance may have reduced treatment efficacy.

Regimen-related toxicity and non-relapse mortality with high-dose cyclophosphamide, carmustine (BCNU) and etoposide (VP16-213) (CBV) and CBV plus cisplatin (CBVP) followed by autologous stem cell transplantation in patients with Hodgkin's disease.

This analysis compares the regimen-related toxicity (RRT) and overall non-relapse mortality (NRM) in Hodgkin's disease patients conditioned with either CBV (cyclophosphamide, BCNU (carmustine), and VP16-213 (etoposide)) (26 patients) or CBVP (CBV + cisplatin) (68 patients) followed by autologous stem cell transplantation (ASCT). CBVP included a continuous infusion rather than intermittent doses of etoposide, a lower BCNU dose and the addition of cisplatin. RRT and NRM were determined for each regimen and compared; risk factors for each were examined by multivariate analysis. Grade IV (fatal) RRT occurred in five patients (pulmonary in two, cardiac in two, and central nervous system in one). Eighteen patients experienced grade II-III pulmonary RRT, consistent with BCNU damage in 15. Prior nitrosourea exposure was the main risk factor for pulmonary RRT. Grade II mucosal and hepatic RRT occurred less often after CBVP vs CBV (P = 0.031 and 0.0003, respectively). In addition, three other early and eight late non-relapse deaths were seen. Median follow-up of the entire group is 5.1 (range 2.8-10.2) years. The probability of overall NRM was 26% (95% confidence interval (CI) 13-50%) with CBV vs 23% (95% CI 12-41%) with CBVP (P = 0.40). The progression-free survival and relapse rates were similar. Although the rates of fatal RRT, pulmonary RRT and overall NRM were similar with CBV or CBVP, CBVP produced less mucosal and liver RRT with a comparable antitumor effect. As many autografted patients are cured, future efforts should include measures to decrease NRM.

Treatment considerations in the elderly patient with lymphoma.

One half of all non-Hodgkin's lymphomas occur in the elderly, a growing segment of the population in North America. Significantly, the incidence of lymphoma in general, and especially in the elderly, is rising rapidly. These trends will combine to double the number of cases of lymphoma in the elderly in the next 2 to 3 decades. Certain lymphomas can be treated as effectively in the elderly as in the young, and others are treatable but with only half the expectation of cure. Further improvements will be made as future clinical investigation focuses on the elderly with lymphoma as a special group.

Prognostic significance of Bcl-2 protein expression and Bcl-2 gene rearrangement in diffuse aggressive non-Hodgkin's lymphoma.

The prognostic significance of Bcl-2 protein expression and bcl-2 gene rearrangement in diffuse large cell lymphomas (DLCL) is controversial. Bcl-2 protein expression prevents apoptosis and may have an important role in clinical drug resistance. The presence of a bcl-2 gene rearrangement in de novo DLCL suggests a possible follicle center cell origin and perhaps a distinct clinical behavior more akin to low-grade non-Hodgkin's lymphoma (NHL). The purpose of this study was to determine the impact of Bcl-2 protein expression and bcl-2 gene rearrangement (mbr and mcr) on survival of a cohort of patients with DLCL who were uniformly evaluated and treated with effective chemotherapy. Patients included the original MACOP-B cohort (n = 121) and the initial 18 patients treated with the VACOP-B regimen (total = 139). All patients had advanced-stage disease, were 16 to 70 years old, and corresponded to Working Formulation categories F, G, or H. No patients had prior treatment, discordant lymphoma, or human immunodeficiency virus seropositivity. Paraffin sections from diagnostic biopsies were analyzed for bcl-2 gene rearrangement including mbr and mcr breakpoints by polymerase chain reaction and Bcl-2 protein expression by immunohistochemistry. With a median follow-up of 81 months, overall (OS), disease-free (DFS), and relapse-free survival (RFS) were measured to determine the prognostic significance of these parameters. Analyzable DNA was present in 118 of 139 (85%) cases, with 14 demonstrating a bcl-2 rearrangement (11 mbr, 3 mcr). All 14 of these bcl-2 gene rearrangement-positive cases were found in the 102 patients with a B-cell immunophenotype, but the presence of this rearrangement had no significant influence on survival. Bcl-2 protein expression was interpretable in 116 of 139 (83%) cases, with immunopositivity detected in 54 of 116 (47%). Using a cut-off of greater than 10% Bcl-2 immunopositive tumor cells for analysis, positive Bcl-2 protein expression was seen in 28 of 116 (24%) patients and the presence of this expression correlated with decreased 8-year OS (34% v 60%, P < .01), DFS (32% v 66%, P < .001), and RFS (25% v 59%, P < .001). Bcl-2 protein expression remained significant in multivariate analysis that included the clinical international prognostic index factors and immunophenotype (P < .02). In conclusion, although bcl-2 gene rearrangement status could not be shown to have an impact on outcome, Bcl-2 protein expression is a strong significant predictor of OS, DFS, and RFS in DLCLs.

Late relapse in patients with diffuse large-cell lymphoma treated with MACOP-B.

PURPOSE: To examine the clinical course of patients who experienced a late relapse after initial curative chemotherapy for advanced-stage diffuse large-cell lymphoma. PATIENTS AND METHODS: Between April 1981 and June 1986, 127 patients with de novo advanced-stage diffuse large-cell lymphoma were treated with a 12-week chemotherapy program (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin [MACOP-B]). The overall survival rate at 10 years is 52%. One hundred six patients (83%) entered a complete remission (CR) and 43 of them relapsed. With a median follow-up duration of 146 months, 26 patients relapsed early and 17 relapsed late, ie, after a continuous CR (cCR) of greater than 24 months. All late relapses occurred in patients with B-cell lymphoma. RESULTS: After 24 months from diagnosis, the rate of late relapse averaged 2.2% per year and reached a projected 22% actuarial risk of late relapse after 10 years. The median time to late relapse was 69 months (range, 38 to 141). Ten patients relapsed with aggressive histologic subtypes and were treated with curative intent using anthracycline-based chemotherapy. Four remain in second CR, one is alive with disease, and five died of disease or while on treatment. The 6-year overall survival rate from the time of relapse (SFR) for these 10 patients is 42%. Six patients relapsed with low-grade follicular lymphoma. These patients received various treatments intended to control, but not necessarily cure disease. One is in second CR, one is alive with disease, and four died of disease or while on treatment. The 6-year overall SFR rate for these six patients is 40%. bcl-2 translocation and Bcl-2 protein expression at diagnosis did not predict for the type of late relapse. One patient did not undergo repeat biopsy at relapse and died 9 months later despite aggressive therapy. CONCLUSION: Curative therapy should be attempted in patients who relapse late with aggressive-histology lymphoma and those who relapse with follicular histology may benefit from palliative treatment. The behavior of late-relapse lymphoma is similar to de novo lymphoma, with outcome dictated by the histologic subtype at relapse.

Malignant lymphomas in the elderly.

More than half of all lymphomas occur in patients aged 60 years or older. This article reviews the management of low-grade and aggressive histology lymphomas in patients older than age 65. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy is well tolerated in patients who have a good performance status and who have aggressive histology lymphoma, but briefer 8-week regimens appear to offer similar benefits more quickly. Age alone is an adverse prognostic factor for lymphomas, but when possible, patients should be offered effective treatment tailored for their age performance status and intercurrent diseases.

Treatment of advanced Hodgkin's disease with chemotherapy--comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group.

PURPOSE: This randomized, prospective trial compares outcomes for patients with advanced Hodgkin's disease treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, and vinblastine (ABV) hybrid regimen or alternating MOPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). METHODS: Three hundred one patients with advanced Hodgkin's disease were randomized to receive MOPP/ ABV hybrid regimen or alternating MOPP/ABVD after stratification for prior treatment, B symptoms, and treatment center. Eligible patients were either previously untreated and found to have stage IIIB, IVA, or IVB disease or previously treated with wide-field irradiation. Responding patients received a minimum of eight cycles of chemotherapy. Those with residual disease in a localized region received irradiation between the sixth and seventh cycle of treatment. RESULTS: Response rates to the two regimens were similar. Five-year overall survival rates were 81% and 83% for MOPP/ABV hybrid and alternating MOPP/ ABVD, respectively (P = .74; 95% confidence interval [CI] for the difference, -11% to 7%). Five-year failure-free survivals were 71% and 67% for MOPP/ABV hybrid and alternating MOPP/ABVD, respectively (P = .87; 95% CI for the difference, -9% to 17%). Significantly more episodes of febrile neutropenia and stomatitis were observed with the MOPP/ABV hybrid regimen; there was no significant difference in fatal toxicity. Patients with predefined, high-quality partial responses (PR-1s) had results similar to those with complete responses (CRs). Planned subset analysis showed no significant difference in outcome between the two arms of the trial for patients with newly diagnosed disease (5-year failure-free survival rates were 70% for MOPP/ABV hybrid and 59% for alternating MOPP/ABVD; P = .180), but superiority of alternating MOPP/ABVD for patients with prior irradiation (5-year failure-free survival 94% v 73%; P = .017). CONCLUSION: MOPP/ABV hybrid and alternating MOPP/ABVD regimens are equally effective for patients with advanced Hodgkin's disease.