Risk-Adapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom
| Autor: | Tarek M. Alsaba, Amany M. Ali, Amira M. Mohamed, Saamer Mansour, Mohamed Elzubier Abdallah, Shimaa Ahmed |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty Chemotherapy business.industry Dacarbazine medicine.medical_treatment medicine.disease Radiation therapy 03 medical and health sciences 030104 developmental biology 0302 clinical medicine ABVD Median follow-up 030220 oncology & carcinogenesis Internal medicine medicine Combined Modality Therapy business Prospective cohort study Progressive disease medicine.drug |
| Zdroj: | Journal of Cancer Therapy. :545-558 |
| ISSN: | 2151-1942 2151-1934 |
| DOI: | 10.4236/jct.2018.97046 |
| Popis: | Background and Objectives: Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life, with long term follow up. We assess the impact of prognostic factors associated with local treatment failure of pediatric HL patients with unfavorable criteria treated with combined modality: Alternating ABVD (Doxorubicin, Bleomycin, Vinblastine and Decarbazine) and COEP (Cyclophosphamide, Oncovin, Etoposide and Prednisone) chemotherapy and response-based, involved-field radiation for newly diagnosed unfavorable pediatric HL patients, also will detect toxicities and long-term complications observed in the patients. Methods: This prospective study was carried out from January 2010 to January 2018, with a median follow up of 74 months (range 8 - 103 months). 54 patients were eligible for this study stratified into two groups: intermediate risk (IR) and high-risk group (HR). Patients were treated with (4 - 6 cycles) and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved a partial response. Results: 27 patients were IR and 27 patients were HR. There were 16 treatment failures; 5 patients had progressive disease; and 11 patients had a relapse. 9 patients died from their disease progression. The 5-year overall survival (OS) and event-free survival (EFS) rates (±SE) were 81.8% ± 5.7% and 71.8% ± 6.2% respectively. Multivariate analysis revealed that the only independent factor for inferior OS was radiotherapy. Conclusion: Treatment results of unfavourable HL patients in our study are satisfactory for with IR group but not for HR group who needs intensification of therapy. Radiotherapy is considered as a cornerstone in the treatment of the patients with unfavourable criteria with better assessment of early responders needed by PET-CT to identify patients at risk for relapse. |
| Databáze: | OpenAIRE |
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