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.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/drug therapy , Hodgkin Disease/radiotherapy , Adolescent , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bleomycin/administration & dosage , Bleomycin/adverse effects , Combined Modality Therapy , Dacarbazine/administration & dosage , Dacarbazine/adverse effects , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Female , Hodgkin Disease/pathology , Humans , Male , Middle Aged , Neoplasm Staging , Radiotherapy Dosage , Risk Factors , Vinblastine/administration & dosage , Vinblastine/adverse effectsABSTRACT
The lymphoid tissues of Waldeyer's ring, including the nasopharynx, are rarely involved in Hodgkin's disease (HD). Between March 1977 and July 2001, about 2150 patients affected by HD were observed in our institute; 7 of them (0.32%), all male patients, had HD of the nasopharynx. They had no symptoms and blood tests were normal. All patients were treated with chemotherapy and/or radiotherapy and achieved complete remission. At a median follow-up of 72 months, they are alive and in continuous complete remission. We conclude that Hodgkin's disease of the nasopharynx is a rare and predominantly male disease with a particularly favorable prognosis. Bone marrow biopsy could be avoided. We believe that two to four cycles of a chemotherapeutic regimen and involved field radiotherapy at an intermediate-high dosage (25-30 Gy) could be the first line treatment for these patients.
Subject(s)
Hodgkin Disease/diagnosis , Nasopharyngeal Neoplasms/diagnosis , Adult , Combined Modality Therapy , Disease-Free Survival , Follow-Up Studies , Hodgkin Disease/therapy , Humans , Incidence , Male , Middle Aged , Nasopharyngeal Neoplasms/therapy , Remission InductionABSTRACT
Surgical repair of ventral hernias may often be quite difficult; however, the use of prosthesis, now generally accepted by many surgeons, has improved the results of such type of surgery. The Authors experience confirm the safety of the expanded PTFE and its versatility of employment, obtaining good functional and aesthetic results.
