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Results of three courses of adriamycin, bleomycin, vindesine, and dacarbazine with subtotal nodal irradiation in 189 patients with nodal Hodgkin's disease (stage I, II and IIIA).
- Source :
-
Hematology and cell therapy [Hematol Cell Ther] 1997 Apr; Vol. 39 (2), pp. 59-65. - Publication Year :
- 1997
-
Abstract
- Aim of the Study: To evaluate in a prospective trial three courses of an ABVD-like chemotherapy (CT) regimen given before radiation therapy (RT) (subtotal nodal irradiation (STNI) in favorable stage Hodgkin's disease (HD). The efficacy, risk factors and medium-term toxicities are reported.<br />Patient Characteristics: Stage I or II with at least one of the following factors, mediastinal involvement, histological type 3, age > 40 years, ESR rate > 50 mm, or stage IIIA. 189 patients with newly diagnosed HD were treated between 01/89 and 01/94 (stage I, n = 33; stage II, n = 129, stage IIIA, n = 27). Three courses of an ABVD-like regimen (adriamycin 25 mg/m2, bleomycin 10 mg, vindesine 2 mg/m2 and dacarbazine 250 mg/m2 day 1 and 8) were given before STNI at 36/40 grays. At diagnosis, prognostic factors were distributed as follows: B symptoms (n = 54), bulky mediastinum (n = 41), hemoglobin < 12 g/dl (n = 37), ESR > 50 (n = 65), age > 45 (n = 24).<br />Results: After chemotherapy, 90% had an objective response (partial response > 75%) and 98% were in complete remission (CR) at the end of RT. Three patients had primary refractory disease and 13 patients (7%) relapsed, 3 at the initial site, 4 at previously uninvolved sites and 6 at both. With a median follow-up of 60 months, 170 patients are in 1st CR, 5 in 2nd or greater CR and 11/14 patients have died from HD. Bulky mediastinum (p = 0.009), age > 45 years (p = 0.03) and EST > 50 mm (p = 0.05) were adverse prognostic factors for survival. Bulky mediastinum (p = 0.009) was the only prognostic factor for freedom from progression. TOXICITIES: Two patients died from treatment related toxicity and one patient died with an osteogenic sarcoma. No secondary leukemia has so far been detected. 24 pregnancies were reported. Cardiopulmonary toxicity was always < grade 1 (WHO) in 95 patients evaluated. Two patients over 45 years old had a myocardial infarction.<br />Conclusion: With an acceptable medium-term toxicity, this treatment achieved 85% survival at 5 years.
- Subjects :
- Adolescent
Adult
Aged
Bleomycin administration & dosage
Combined Modality Therapy
Dacarbazine administration & dosage
Doxorubicin administration & dosage
Female
Gonads drug effects
Gonads radiation effects
Heart drug effects
Heart radiation effects
Hodgkin Disease pathology
Humans
Lung drug effects
Lung radiation effects
Male
Middle Aged
Neoplasm Staging
Neoplasms, Second Primary
Prospective Studies
Radiotherapy adverse effects
Survival Rate
Thyroid Gland drug effects
Thyroid Gland radiation effects
Treatment Outcome
Vinblastine administration & dosage
Vindesine administration & dosage
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Hodgkin Disease drug therapy
Hodgkin Disease radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1269-3286
- Volume :
- 39
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Hematology and cell therapy
- Publication Type :
- Academic Journal
- Accession number :
- 9168301
- Full Text :
- https://doi.org/10.1007/s00282-997-0059-7