Risk-Adapted Combined Radiotherapy and Chemotherapy for Hodgkin’s Disease – Results of a Pilot Study

Abstract

Background: In an open pilot study we tested a program of reduced combined radio-chemotherapy in Hodgkin’s disease in limited stages with risk factors and in advanced stages. Aim of the study was to reduce the delayed complications of full-dose combined modality treatment while preserving its effectiveness. Material and Methods: From May 1985 to December 1988 43 previously untreated consecutive patients entered the study. Treatment consisted of CVPP/ABVCy hybrid chemotherapy and low-dose (25 Gy) involved-field radiotherapy. Results: All patients could be evaluated for response to treatment. Primary complete remission (CR) reached 35/43, partial remission 5/43 (12%), and 3/43 (7%) did not respond. After a median observation period of 64 months 28/35 (80%) are in first CR. The survival data are as follows: relapse-free survival 3 years 86%, 5 years 78%, overall survival 3 years 91%, 5 years 83% (Kaplan-Meier estimation). So far 7 patients relapsed and 7 patients died. The acute toxicity of the treatment program was acceptable and up to now we have not observed secondary neoplasms. Conclusions: We regard our treatment approach as useful; it matches the reports of other groups using similar treatment policies.

Photoperiod Influences the Central Effects of Ghrelin on Food Intake, GH and LH Secretion in Sheep

“…Specifically, i.c.v. leptin inhibits appetite in SD but not in LD [25, 26]. This supports the emerging hypothesis that reciprocal signalling by ghrelin and leptin may be critical in energy balance regulation [37].…”

“…The refusal margin was over 10% and the sheep were unable to selectively consume any of the separate constituents.Water was provided ad libitum. Cannulation of the third cerebral ventricle (3V) was undertaken in 24-hour fasted sheep maintained on halothane anesthesia (∼2% Halothane BP, Concord Pharmaceuticals Ltd., Essex, UK) as previously reported [25]. While under general anesthesia, each sheep was also given two subcutaneous estradiol-containing implants made from silastic tubing (15 × 4 mm) [26] which gave average plasma estradiol concentrations of 2.6 ± 0.33 pg/ml (measured at the start, middle and end of the experiment by radioimmunoassay) [29].…”

“…Sheep are seasonal animals with respect to appetite and reproductive activity, and photoperiod has been shown to influence hypothalamic responses to alterations in nutritional feedback provided, for example, by peripheral glucose infusion [24] or by central leptin injection [25, 26]. It is therefore pertinent to examine the effect of season (photoperiod) on hypothalamic responses to ghrelin.…”

“…It is therefore pertinent to examine the effect of season (photoperiod) on hypothalamic responses to ghrelin. In the present study, estradiol-implanted castrated male sheep were used, as in our earlier studies of central leptin administration [25, 26], in order to provide a model with constant physiological concentrations of gonadal steroid feedback. This produces tonic restraint to GnRH output, whilst avoiding the photoperiod-driven changes in circulating steroid concentrations shown by gonad-intact animals [27].…”

Entwicklungsgeschichte: Bendamustin gestern, heute, morgen

“…Diese wurde mit dem CVPP-Schema (Cyclophosphamid, Vinblastin, Procarbazin und Prednisolon) bei Patienten mit fortgeschrittenem Hodgkin-Lymphom verglichen, wobei sich keine Überlegenheit der alternierenden Therapie ergab [6]. Daraufhin wurde in einer offenen Pilotstudie der zusätzliche Einsatz einer kombinierten Radiotherapie bei 43 unbehandelten Hodg kin-Patienten mit hohem Risiko (fortgeschrittenes Stadium, B-Symptomatik, Bulky Disease (massiver Lymphombefall eines Lymphknotens) oder/und extranodale Läsionen) getestet [7,8,9]. Die Behandlung umfasste in einem 28-tägigen Zyklus die Gabe von CVPP/DBVCy mit Bendamustin in einer Dosierung von 30 mg/m 2 an den Therapietagen 8-12.…”