The effective use of combined modality therapy for the treatment of patients with Hodgkinʼs disease who relapsed following radiotherapy

Cadman, Ed; Bloom, Alan F.; Prosnitz, Leonard R.; Farber, Leonard R.; Vera, Raúl; Bertino, Joseph R.; Fischer, Dennis; Lawrence, R. F.

doi:10.1097/00000421-198306000-00010

Cited by 12 publications

(3 citation statements)

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“…However, BEACOPP may further improve outcome of salvage after radiotherapy relapse compared to alternating protocols, such as MOPP/ABVD or COPP/ABVD. Other means for salvage intensification after RX relapse applied in earlier studies were additional radiotherapy either in subgroups or in all patients [3,8,11]. The main prognostic factor in our study was age (for both FF2F and OS), B symptoms (for FF2F and OS) and extranodal involvement (for OS) were also of relevance.…”

Section: Discussionmentioning

confidence: 68%

“…Common risk factors for second relapse and survival after radiotherapy recurrence include age above 40 or 50 [3,8,9], B symptoms at relapse [3,10,11], advanced stage at relapse [3,6,8,10], and site of relapse [5,6]. Several other prognostic factors were observed in some studies, including histologic subtype [4,6], time interval until relapse [12], and type of salvage treatment [11,13].…”

Section: Introductionmentioning

confidence: 99%

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BEACOPP and COPP/ABVD as salvage treatment after primary extended field radiation therapy of early stage Hodgkins disease – Results of the German Hodgkin Study Group

Rüffer

Ballova

Glossmann

et al. 2005

Leukemia & Lymphoma

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Patients with early stage favorable Hodgkin's disease who relapse after extended field radiotherapy have satisfactory results. We retrospectively analysed patients with relapsed HD after initial radiation therapy alone to determine treatment outcome and prognostic factors. Nine-hundred and forty five patients in localized stages without risk factors received either 40 Gy extended field RT or 30 Gy EF RT followed by an additional 10 Gy to involved lymph node regions. 107 patients relapsed and received salvage therapy. Characteristics of the 107 patients at relapse were as follows: median age was 34 years (range 18--75) with relapse occuring at a median of 19 months (range 4--98 months), 31% were female. The majority of patients (93%) were treated with conventional chemotherapy. Sixty-nine percent were treated with COPP/ABVD like regimens, 21% with BEACOPP, and 3% received various other regimens. Seven percent were treated with radiotherapy alone. Complete remission was achieved in 87% of all salvaged patients. The median follow-up after relapse was 45 months. FF2F (freedom from second treatment failure) and OS (overall survival) were 81% and 89%, respectively. In multivariate analysis age was the major prognostic factor for FF2F and OS (p<0.0001, for both). Further independent prognostic factors were B symptoms (p=0.05) and salvage chemotherapy (p=0.03) for FF2F, and B symptoms (p=0.03) and extranodal involvement (p=0.02) for OS. The long-term outcome of patients relapsing after EF RT is excellent. Age, B symptoms, extranodal involvement and salvage chemotherapy were identified as prognostic factors for second relapse and survival.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

BEACOPP and COPP/ABVD as salvage treatment after primary extended field radiation therapy of early stage Hodgkins disease – Results of the German Hodgkin Study Group

Rüffer

Ballova

Glossmann

et al. 2005

Leukemia & Lymphoma

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“…While these results may be interpreted as a caveat against overtreatment of patients, it has to be pointed out that relapse in elderly patients carries a significantly higher risk of lower cure rates than in younger patients. In view of the poor efficacy of salvage chemotherapy in elderly patients [15,47,48], treatment regimens aiming at primary cure, i.e. at high RFS rates, are advocated.…”

Section: Cmt Versus Irradiation In Localized Diseasementioning

confidence: 99%

Prognosis and Management Strategies of Lymphatic Neoplasias in the Elderly

Greil¹

1998

Oncology

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In Caucasians, Hodgkin’s disease demonstrates constant incidence rates, with a first peak occurring in adolescents and in young adults, and a second peak in the elderly. Age is an important risk factor for overall survival of patients; staging strategies and treatment expose elderly patients to an even higher risk arising from surgical complications, death from secondary cancer and leukemia or lethal cardiac complications. In contrast to non-Hodgkin’s lymphoma, optimal staging and treatment procedures have not yet been defined for this disease in elderly patients. However, due to the very poor prognosis of inadequately treated patients, treatment recommendations at present must be based on those for younger patients while keeping the individual risk profile in mind. If staging laparotomy is omitted, most patients will require a combined modality treatment. While in low-risk patients a reduced number of cycles with full-dose chemotherapy like ABVD (Adriblastina, bleomycin, vinblastine, dacarbazine) or of six cycles with less toxic drugs like VBM (vinblastine, bleomycin, methotrexate) followed by limited field radiotherapy may suffice, patients with well-defined risk factors will require a more prolonged chemotherapy. Currently, there is no evidence that C(M)OPP [cyclophosphamide (mustargen), vincristine, procarbazine, prednisone]/ABVD or ABVD may successfully be replaced by less toxic regimens. Therefore, further studies are required on the specific definition of biological age, the cost/benefit ratio of staging procedures and treatment and the influence of these strategies on the quality of life in the elderly.

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