Dose-response relationship of complementary radiotherapy following four cycles of combination chemotherapy in intermediate-stage Hodgkin's disease

Loeffler, Markus; Diehl, Volker; Pfreundschuh, M.; Rühl, U; Hasenclever, Dirk; Nisters-Backers, H; Sieber, M.; Tesch, Hans; Franklin, James; Geilen, Wilhelm; Bartels, H.; Cartoni, Claudio; Dölken, Gottfried; Enzjan, J; Fuchs, Roland J.; Gaβmann, W.; Gerhartz, H; Hagen-Aukamp, U; Hiller, Erhard; Hinkelbein, H.; Hinterberger, W; Kirchner, Hartmut; Koch, P.; Küger, B; Kürten, H.; Kutzner, Karl Philipp; Loos, Julia; Mende, Wolfgang; Müller, Horst; Oertel, W. H.; Petsch, S.; Pfab, R; Plfüger, H; Rohloff, R.; Sauer, Rolf; Schalk, K. P.; Schick, HD; Schoppe, W. D.; Szepesi, S.; Teichmann, J. V.; Worst, P.; Fischer, R.; Georgii, A.; Hübner, K.; Ew, Schwarze

doi:10.1016/s1278-3218(98)89074-4

Cited by 11 publications

(13 citation statements)

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“…Forty-three patients were treated at the pediatric center (Von Haunersches Children's Hospital of the University of Munich, R. Haas, Division of Pediatric Hematology). Most adult patients diagnosed after [1984][1985][1986][1987] were treated according to study protocols of the German Hodgkin's Lymphoma Study Group [30,34]. Briefly, patients diagnosed at an early stage underwent radiation therapy.…”

Section: Treatment Strategiesmentioning

confidence: 99%

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Second malignancies after Hodgkin's disease: the Munich experience

Munker¹,

Grützner²,

Hiller³

et al. 1999

Annals of Hematology

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The occurrence of second malignancies (SM) is an important late event following the treatment of Hodgkin's disease (HD). We sought to determine the incidence, the risk factors, and the prognosis of SM in our population of patients with HD. A total of 1120 patients diagnosed with HD were registered at six participating institutions in Munich (calendar period 1974-1994). The mean follow-up for the development of SM was 9.1 years. A cumulative treatment score was calculated for both radio- and chemotherapy. The relative and absolute risks of SM were established. All SM were investigated for response to treatment and outcome. We observed 85 SM [eight leukemias, 22 non-Hodgkin's lymphomas (NHL), two plasma cell neoplasias, and 53 solid tumors]. Five patients developed third malignancies. The relative risk of developing a second neoplasm was compared with that within the normal population and was 3.1-fold. The risk varied according to the category of SM. Higher relative risks (20.5 and 25.9-fold), but lower absolute risks were observed for leukemias and non-Hodgkin's lymphomas. Solid tumors had lower relative risks (1.8-fold). Splenectomy increased the risk of SM (relative risk 4.4-fold versus 2.7-fold). The risk of SM did not correlate with the initial treatment (radio- or chemotherapy) and did not decrease with prolonged follow-up. The cumulative intensity of radiotherapy, chemotherapy, or the two modalities combined correlated with the risk of SM. Since some cases occurred early after diagnosis, not all second neoplasms can be considered treatment-associated. After 15 years, an actuarial risk of 11.7% was calculated for all SM, of 1.0% for leukemias, of 3.0% for NHL, and of 7.7% for solid tumors. The prognosis of SM varied between good (thyroid cancer, melanoma: median survival 5+ years), average (breast cancer, NHL), and poor (acute myeloid leukemias, lung cancers: median survival 9 months). With the exception of NHL, second cancers often occurred in topographic relation to the field of previous radiotherapy. Taken together, in our patient population, we observed all three categories of SM (solid tumors, leukemias, NHL). The risk for second leukemias is lower than in previous studies, whereas the risk of second NHL is somewhat higher. We confirm that splenectomy is a possible risk factor for SM. Even after correction for the age-specific cancer incidence, treatment intensity is associated with the development of second malignant tumors. Continued follow-up is mandatory after treatment for HD. Since the prognosis of most SM is unfavorable, early recognition and prevention are of the utmost importance.

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Section: Treatment Strategiesmentioning

confidence: 99%

“…Children were treated according to pediatric protocols. These consist of two to six cycles of chemotherapy and low-dose irradiation (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) depending on the stage [41].…”

Section: Treatment Strategiesmentioning

confidence: 99%

Second malignancies after Hodgkin's disease: the Munich experience

Munker¹,

Grützner²,

Hiller³

et al. 1999

Annals of Hematology

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“…No significant differences were found among the three different dose levels for non-bulky disease [26]. Several ongoing studies are evaluating RT dose following chemotherapy for early-stage disease.…”

Section: Combined-modality Treatment For Early-stage Hd: Rt Dose Consmentioning

confidence: 91%

Changing role and decreasing size: Current trends in radiotherapy for hodgkin’s disease

Yahalom

2002

Curr Oncol Rep

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Radiotherapy, the first cancer treatment modality that offered cure, is still considered to be the most effective "single agent" in treating Hodgkin's disease (HD). Yet, the role of radiotherapy in HD has changed dramatically with the advent of effective combination chemotherapy and the rising concern of long-term complications associated with successful treatment of HD. The new principles of integrating radiotherapy into a combined-modality regimen for HD at different prognostic stages are reviewed here, along with the effect of this new role on radiation field size and design.

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“…Ainsi, dans les anné es 1990, plusieurs groupes investigateurs ont essayé de dé velopper des traitements combinant radiothé rapie et chimiothé rapie, jusqu'alors ré servé s aux formes avancé es, afin d'optimiser les ré sultats de la radiothé rapie seule et de diminuer à la fois les champs et les doses d'irradiation et par consé -quent la toxicité tardive. De l'ensemble de ces é tudes, il peut ê tre retenu que (a) le traitement combiné est plus efficace et moins toxique que la radiothé rapie seule [34], (b) lorsque la radiothé rapie est associé e à une chimiothé rapie, le champ d'irradiation peut ê tre limité aux sites ganglionnaires initialement atteints : radiothé rapie de type « involved-fields » ou RTIF [3], (c) la dose dé livré e peut ê tre ré duite de 40 à 30 Grays voire moins [27] (d) que quatre cycles de chimiothé rapie de type ABVD (adriamycine, blé omycine, vinblastine et dacarbazine), sont au moins aussi efficaces et moins toxiques que la chimiothé rapie de type MOPP [8] (mé chloré thamine, vincristine, procarbazine, et prednisone) et sont suffisants [9]. Ainsi, l'association 4 ABVD + irradiation 30 Gy « involved fields » est dé sormais considé ré e comme le traitement standard pour les stades limité s.…”

Section: Traitement Des Stades Limité S Standard Thé Rapeutiqueunclassified

Lymphome de Hodgkin (LH): avancées et perspectives récentes

Italiano

Thyss

2006

Oncologie

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Ré sumé : On sait que la cellule de Reed-Sternberg (cRS) dé rive de cellules B activé es post-germinales ayant é chappé à l'apoptose. Les é tudes sur cRS microdissé qué es commencent à en dé finir le profil gé nomique. Le traitement actuel des formes limité es de LH est une courte chimiothé rapie par ABVD, trois ou quatre cycles, suivie d'une radiothé rapie « involved fieds ». Les é tudes en cours cherchent à ré duire la chimiothé rapie et/ou la radiothé rapie pour ré duire encore les consé quences iatrogè nes notamment tardives. La question d'une chimiothé rapie exclusive est posé e, notamment pour les « ré pondeurs rapides ». Le traitement standard des formes avancé es est une chimiothé rapie exclusive par ABVD, six à huit cycles. Le BEACOPP, proposé par le GHSG n'apporte pas de bé né fice à dose standard et paraît trop toxique à dose renforcé e. Le traitement des rechutes est hé té rogè ne, selon le site (irradié ou non), le dé lai et la chimiosensibilité seconde. L'intensification thé rapeutique avec support de CSH (autogreffe) est licite pour les rechutes pré coces et les formes ré fractaires, en cas de ré ponse à la seconde ligne. La place de l'allogreffe paraît trè s limité e.Mots clé s : Lymphome de Hodgkin -Physiopathologie -Chimioth-é rapie -ABVD -Radiothé rapieAutogreffeHodgkin's lymphoma (HL): recent advances and prospects Abstract: It is known that the Reed-Sternberg cell (RSc) derives from activated post-germinal B cells which have escaped apoptosis. Studies on micro-dissected RSc are now beginning to clarify the genomic profile. For limited stages of HL the standard treatment is short chemotherapy with ABVD, 3 or 4 cycles, followed by involved fields radiotherapy. Current trials try to reduce the duration of chemotherapy and/or dose of radiotherapy, in the hope of reducing secondary (especially late) effects. Exclusive chemotherapy, specially for fast responders is discussed. Standard treatment for advanced stages is exclusive chemotherapy with 6-8 cycles of ABVD. The BEACOPP regimen proposed by the GHSG gives no benefit at standard doses and is too toxic at escalated doses. Treatment of relapses is heterogeneous, depending on the site (irradiated or not), the delay from first line and response to second line chemotherapy. Intensive chemotherapy with HSCT (autograft) seems reasonable for early relapse and refractory diseases responding to second line chemotherapy. The current place for allograft seems very limited.

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Dose-response relationship of complementary radiotherapy following four cycles of combination chemotherapy in intermediate-stage Hodgkin's disease

Cited by 11 publications

References 0 publications

Second malignancies after Hodgkin's disease: the Munich experience

Second malignancies after Hodgkin's disease: the Munich experience

Changing role and decreasing size: Current trends in radiotherapy for hodgkin’s disease

Lymphome de Hodgkin (LH): avancées et perspectives récentes

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