Extended-field radiotherapy in favorable stage IA-IIA Hodgkin's disease (prognostic role of stage)
| Autor: | Franco Rilke, Liliana Devizzi, Simonetta Viviani, Roberto Zucali, V. Bonfante, F. Villan, Marcello Zanini, Alberto Banfi, Antonella Santoro, M.R. Castellani, F. Soncini, E. Negretti |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Vincristine Adolescent medicine.medical_treatment Dacarbazine Salvage therapy Procarbazine Vinblastine Bleomycin Risk Factors Antineoplastic Combined Chemotherapy Protocols medicine Humans Radiology Nuclear Medicine and imaging Mechlorethamine Stage (cooking) Cyclophosphamide Aged Epirubicin Etoposide Neoplasm Staging Salvage Therapy Univariate analysis Radiation business.industry Neoplasms Second Primary Middle Aged Prognosis Combined Modality Therapy Hodgkin Disease Surgery Radiation therapy Oncology Doxorubicin Prednisone Female business medicine.drug Follow-Up Studies |
| Zdroj: | International journal of radiation oncology, biology, physics. 30(4) |
| ISSN: | 0360-3016 |
| Popis: | Purpose: The study was undertaken to evaluate the long-term results in a favorable subset of patients with pathological Stage IA–IIA treated with irradiation alone. Methods and Materials: One hundred and forty-seven adults with laparotomy- Staged IA–IIA "favorable" Hodgkin's disease were treated with primary subtotal nodal irradiation. Patients with infradiaphragmatic presentation were irradiated through paraortic and inguino-iliac node chains (inverted Y field) followed by prophylactic mediastinal and supraclavicular fields. Results: Actuarial overall survival (OS) at 7 years (median follow-up 77 months) was: 93% for the whole series, 94% for Stage I, and 92% for Stage II. The freedom from first progression (FFP) (80% for the whole series) showed a statistically significant difference ( p = 0.008) between Stage I (88%) and Stage II (71%). By univariate analysis, stage alone had an independent prognostic significance for OS and FFP. Of the 29 relapsed patients, 8 were previously classified as Stage I and 21 as Stage II; 16 of 29 (55%) of the relapses occurred in the pelvis and 9 in extranodal sites. After salvage treatment with chemotherapy all patients achieved a second complete remission. Seven second malignancies (two acute nonlymphocytic leukemias, one preleukemic syndrome, and four solid tumors) have been detected so far. Hypothyroidism was observed in 16% of patients and a reversible pulmonary restrictive syndrome in 14% of cases, respectively. Conclusions: Within 7 years from radiation therapy, about one-quarter of the patients with Stage II disease will experience a relapse and need intensive salvage chemotherapy. This is not invariably successful and safe, for it may be complicated by either acute or potentially fatal long-term adverse effects, such as second malignancies and cardiac or pulmonary sequelae, in about 5% of patients. The high frequency of relapse in Stage IIA patients suggests a combined modality approach with relatively short-term chemotherapy not including alkylating agents. |
| Databáze: | OpenAIRE |
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