Extended-field radiotherapy is superior to MOPP chemotherapy for the treatment of pathologic stage I-IIA Hodgkin's disease: eight-year update of an Italian prospective randomized study.

Gp, Biti; Cimino, Giuseppe; Cartoni, Claudio; Sm, Magrini; Anselmo, Anna Paola; Enrici, R. Maurizi; Bellesi, Gp; Bosi, Alberto; Papa, G; Giannarelli, Diana

doi:10.1200/jco.1992.10.3.378

Cited by 118 publications

(31 citation statements)

References 15 publications

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“…Sieber et al, 2000). There are limited data on chemotherapy alone in early Hodgkin's disease, and it is uncertain whether disease control rates are as high as with radiotherapy or combined modality approaches (Biti et al, 1992). A current Canadian trial is investigating ABVD in this role.…”

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confidence: 99%

Second primary breast cancer after Hodgkin's disease

Horwich

Swerdlow

2004

Br J Cancer

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Although the potential carcinogenic risk of radiotherapy is well known, it has become clear that there is a particularly high risk of radiation-induced breast cancer in women treated for Hodgkin's disease at young ages. Thankfully, death from breast cancer in this population is uncommon, but it is important to understand factors contributing to the risk, including treatment parameters, and to develop a logical and efficient method for medical management of those at risk. In this minireview, we examine the evidence which should inform such a management policy. The prognosis of patients with Hodgkin's disease has been improved dramatically over the last 40 years by the development of extended field radiotherapy techniques and then by combination chemotherapy (DeVita et al, 1980;Rosenberg and Kaplan, 1985). However, long-term follow-up of survivors has demonstrated that a price of this success has been an increased risk of second cancers. Acute leukaemia frequently occurs in the first decade after treatment, mainly as a consequence of chemotherapy regimens that included an alkylating agent (Tucker et al, 1988;Kaldor et al, 1990;Swerdlow et al, 2000). In the long term, however, the absolute excess risks of a second solid cancer are higher (Swerdlow et al, 2000;Ng et al, 2002b; and are linked mainly with radiotherapy, although for some sites, such as lung cancer, there may be a substantial risk also from chemotherapy (Swerdlow et al, 2000;Travis et al, 2002). Recent reports from The Netherlands and from an international consortium of cancer registries have refined our understanding of how therapy may affect breast cancer risk.The relative risks of many cancers are higher if patients have been treated for Hodgkin's disease at a younger age (Swerdlow et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002). Thus, although the risk of breast cancer is only about 50% increased in most all-age studies of women with Hodgkin's disease (van Leeuwen et al, 1999), relative risks are far larger than this in patients treated at young ages, especially those treated in childhood and adolescence (Hancock et al, 1993;Bhatia et al, 1996b); for them this is one of the main long-term sequelae of radiotherapy. This effect of age is unsurprising, as similar gradients are seen in other cohorts of radiation-exposed women (United Nations Scientific Committee on the Effects of Atomic Radiation, 1994).The size of risk of breast cancer found in Hodgkin's disease patients has varied between studies. For patients treated under age 21 years relative risks have generally been around 15 -25 (Hancock et al, 1993;Sankila et al, 1996;Wolden et al, 1998;Metayer et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002), although they have been less raised (Neglia et al, 2001) or more raised (Mauch et al, 1996;Bhatia et al, 1996b;Aisenberg et al, 1997;Ng et al, 2002b) than this in a few studies; absolute excess risks have generally been of the order of 20 -40 per 10 000 per annum. Relative risks have been greater for patients treated at ages 10 -16 than at...

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confidence: 99%

Second primary breast cancer after Hodgkin's disease

Horwich

Swerdlow

2004

Br J Cancer

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Once patients relapse after initial therapy, however, conventionaldose chemotherapy regimens usually fail to provide durable complete remissions. [17][18][19][20][21][22][23][24] In the series with the longest follow-up, Longo and associates 17 reported that although 93% of relapsing patients could be re-induced into a second complete remission, only 17% of these remissions were durable.…”

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Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR)

Lazarus

Loberiza

Zhang

et al. 2001

Bone Marrow Transplant

109

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Summary:Although patients with relapsed Hodgkin's disease have a poor prognosis with conventional therapies, high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autotransplantation) may provide long-term progression-free survival. We reviewed data from the Autologous Blood and Marrow Transplant Registry (ABMTR) to determine relapse, disease-free survival, overall survival, and prognostic factors in this group of patients. Detailed records from the ABMTR on 414 patients with Hodgkin's disease in first relapse (n = 295) or second complete remission (CR) (n = 119) receiving an autotransplant from 1989 to 1995 were reviewed. Median age was 29 (range, 7-64) years. Median time from diagnosis to relapse was 18 (range, 6-219) months; median time from relapse to transplant was 5 (range, Ͻ1-215) months. Most patients received high-dose chemotherapy without total body irradiation for conditioning (n = 370). The most frequently used high-dose regimen was cyclophosphamide, BCNU, VP-16 (CBV) (n = 240). The graft consisted of bone marrow (n = 246), blood stem cells (n = 112), or both (n = 56).

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“…Initial experience was limited to MOPP or similar alkylator-intense therapies; results of RCTs were inconsistent, [18][19][20] and many considered the associated sterility and leukemogenic risks to be unacceptable. Testing of epirubicin, bleomycin, vinblastine, and prednisone in an RCT was abandoned because of unacceptable rates of disease progression.…”

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confidence: 99%

Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy

Meyer

Hoppe

2012

Blood

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Extended-field radiotherapy is superior to MOPP chemotherapy for the treatment of pathologic stage I-IIA Hodgkin's disease: eight-year update of an Italian prospective randomized study.

Abstract: We conclude that RT alone is the treatment of choice for adult patients with ESHD with favorable prognostic factors.

Cited by 118 publications

References 15 publications

Second primary breast cancer after Hodgkin's disease

Second primary breast cancer after Hodgkin's disease

Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR)

Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy

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