Abstract. Background: To improve long-term survival by reducing toxicity in intermediate stage Hodgkin’s disease patients, we compared the effects of involved field (IF) versus extended field (EF) irradiation administered after four cycles of ABVD regimen. Materials and Methods: Two hundred and ten Hodgkin’s disease patients, at clinical stage II with risk factors and III without risk factors, were enrolled in the randomized study HD94. After four courses of ABVD regimen, patients who achieved complete remission (CR) or partial remission (PR) were randomly assigned to the IF or EF arm. The Kaplan-Meier method was adopted to estimate overall survival (OS) and relapse-free survival (RFS). Results: After a median follow-up of 78 months (range 13-111 months), OS was 98% and 96%, respectively, in the EF and IF arms; RFS was 94% and 91%, respectively, in the EF and IF arms. Conclusion: We confirm the efficacy of four cycles of ABVD regimen, with suitable dose intensity, and radiotherapy as consolidation therapy, in intermediate stage Hodgkin’s disease patients (CR=99.5% and OS= 95%). We also found that involved field radiotherapy results were as effective as extended field, without acute toxicity Modern polychemotherapy regimens associated with radiotherapy have dramatically improved the outcome of advanced and early stage Hodgkin’s disease (HD), with longterm survival rates of 70% and 80%, respectively. It is generally accepted that intermediate stage HD patients should receive four to six cycles of polychemotherapy, followed by radiotherapy as involved field or extended field type, considering that most relapses occur in the lymph nodes involved at diagnosis. Trials which compare radiotherapy (RT) versus no RT after conventional chemotherapy, have shown that patients who underwent RT improved continuous complete remission (CCR) duration by 11% at 10 years, with relapse risk decreasing from 45% to 30% (1). However, the dose and extension of radiation therapy have not yet been precisely defined. Moreover, patients who received both chemotherapy and radiotherapy have also experienced major toxic side-effects from both types of treatment including thyroid, cardiovascular, pulmonary, digestive and gonadal dysfunction, as well as secondary malignancies. With the aim of reducing the risk of secondary malignancies (2, 3), new chemotherapeutic protocols without alkylating agents have been proposed, planning an administration of non crossresistant drugs over a short time period. Thus, it is important to evaluate the risk of developing a secondary cancer in patients treated with Extended Field (EF) RT compared to those receiving Involved Field (IF) RT, in patients undergoing these new chemotherapeutic regimens (4). Recently, a randomised study by the German Hodgkin’s Lymphoma Study Group defined four cycles of polychemotherapy followed by 30 Gy IF RT as standard treatment in patients with early stage unfavorable HD (5). We report the preliminary results of an ongoing prospective randomized study on 210 patients with HD clinical stage II with risk factors and III without risk factors, treated with four monthly courses of ABVD regimen, randomly followed by IF RT or EF RT. The appropriate extension of the radiation field in terms of complete remission, overall survival, relapse-free survival and secondary malignancy occurence was analyzed.
INTERMEDIATE STAGE HODGKIN’S DISEASE: PRELIMINARY RESULTS ON 210 PATIENTS TREATED WITH FOUR ABVD CHEMOTHERAPY CYCLES PLUS EXTENDED VERSUS INVOLVED FIELD RADIOTHERAPY / Anselmo, Anna Paola; E., Cavalieri; Osti, Mattia Falchetto; M., Cantonetti; DE SANCTIS, Vitaliana; Alfo', Marco; S., Amadori; MAURIZI ENRICI, Riccardo. - In: ANTICANCER RESEARCH. - ISSN 0250-7005. - (2004).
INTERMEDIATE STAGE HODGKIN’S DISEASE: PRELIMINARY RESULTS ON 210 PATIENTS TREATED WITH FOUR ABVD CHEMOTHERAPY CYCLES PLUS EXTENDED VERSUS INVOLVED FIELD RADIOTHERAPY
ANSELMO, Anna Paola;OSTI, Mattia Falchetto;DE SANCTIS, Vitaliana;ALFO', Marco;MAURIZI ENRICI, Riccardo
2004
Abstract
Abstract. Background: To improve long-term survival by reducing toxicity in intermediate stage Hodgkin’s disease patients, we compared the effects of involved field (IF) versus extended field (EF) irradiation administered after four cycles of ABVD regimen. Materials and Methods: Two hundred and ten Hodgkin’s disease patients, at clinical stage II with risk factors and III without risk factors, were enrolled in the randomized study HD94. After four courses of ABVD regimen, patients who achieved complete remission (CR) or partial remission (PR) were randomly assigned to the IF or EF arm. The Kaplan-Meier method was adopted to estimate overall survival (OS) and relapse-free survival (RFS). Results: After a median follow-up of 78 months (range 13-111 months), OS was 98% and 96%, respectively, in the EF and IF arms; RFS was 94% and 91%, respectively, in the EF and IF arms. Conclusion: We confirm the efficacy of four cycles of ABVD regimen, with suitable dose intensity, and radiotherapy as consolidation therapy, in intermediate stage Hodgkin’s disease patients (CR=99.5% and OS= 95%). We also found that involved field radiotherapy results were as effective as extended field, without acute toxicity Modern polychemotherapy regimens associated with radiotherapy have dramatically improved the outcome of advanced and early stage Hodgkin’s disease (HD), with longterm survival rates of 70% and 80%, respectively. It is generally accepted that intermediate stage HD patients should receive four to six cycles of polychemotherapy, followed by radiotherapy as involved field or extended field type, considering that most relapses occur in the lymph nodes involved at diagnosis. Trials which compare radiotherapy (RT) versus no RT after conventional chemotherapy, have shown that patients who underwent RT improved continuous complete remission (CCR) duration by 11% at 10 years, with relapse risk decreasing from 45% to 30% (1). However, the dose and extension of radiation therapy have not yet been precisely defined. Moreover, patients who received both chemotherapy and radiotherapy have also experienced major toxic side-effects from both types of treatment including thyroid, cardiovascular, pulmonary, digestive and gonadal dysfunction, as well as secondary malignancies. With the aim of reducing the risk of secondary malignancies (2, 3), new chemotherapeutic protocols without alkylating agents have been proposed, planning an administration of non crossresistant drugs over a short time period. Thus, it is important to evaluate the risk of developing a secondary cancer in patients treated with Extended Field (EF) RT compared to those receiving Involved Field (IF) RT, in patients undergoing these new chemotherapeutic regimens (4). Recently, a randomised study by the German Hodgkin’s Lymphoma Study Group defined four cycles of polychemotherapy followed by 30 Gy IF RT as standard treatment in patients with early stage unfavorable HD (5). We report the preliminary results of an ongoing prospective randomized study on 210 patients with HD clinical stage II with risk factors and III without risk factors, treated with four monthly courses of ABVD regimen, randomly followed by IF RT or EF RT. The appropriate extension of the radiation field in terms of complete remission, overall survival, relapse-free survival and secondary malignancy occurence was analyzed.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.