ABSTRACT
The aim of the study was to raise efficacy of combined treatment of stage II Hodgkin's disease by optimization of fractionation and volume of irradiation. It included 179 patients with involvement of supradiaphragmatic lymph nodes treated in 1986-2006. It was found that multi-fractionation was followed by lower frequency of relapse as compared with standard regimens as well as rates of early ones. The most efficient dosage was 30-36 Gy as far as frequency, term of relapse occurrence and recurrence-free survival were concerned.
Subject(s)
Hodgkin Disease/pathology , Hodgkin Disease/therapy , Adolescent , Adult , Aged , Disease-Free Survival , Dose Fractionation, Radiation , Female , Hodgkin Disease/mortality , Hodgkin Disease/radiotherapy , Humans , Male , Middle Aged , Neoplasm Staging , Radiotherapy Dosage , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Survival Analysis , Time Factors , Treatment Outcome , Young AdultABSTRACT
Significantly lower frequency of relapse, incidence of pulmonitis and pericarditis, leukopenia and thrombocytopenia stage IV and longer recurrence-free survival were reported after acceleration of multifractionation of STD of 1.35Gy was used for treatment of patients with primary Hodgkin's disease, as compared with standard fractionation. When STD was reduced to 1.2Gy (modified multifractionation), subtotal exposure of lymph nodes was followed by a significant drop in frequency and severity of leukopenia and thrombocytopenia stage III-IV. The latter complications, rates decreased further, with perspective response to therapy, as irradiation was limited to that of areas exposed during modified multifractionation.
Subject(s)
Dose Fractionation, Radiation , Hodgkin Disease/radiotherapy , Adult , Aged , Biomedical Research , Disease-Free Survival , Female , Humans , Incidence , Kaplan-Meier Estimate , Leukopenia/epidemiology , Leukopenia/etiology , Male , Middle Aged , Pericarditis/epidemiology , Pericarditis/etiology , Pneumonia/epidemiology , Pneumonia/etiology , Radiotherapy/adverse effects , Recurrence , Retrospective Studies , Russia/epidemiology , Severity of Illness Index , Thrombocytopenia/epidemiology , Thrombocytopenia/etiology , Treatment OutcomeABSTRACT
Depending on size of intrathoracic lymph nodes, 65 patients with Hodgkin's disease (stage II) were divided into two groups using the mediastinal-thoracic index (MTI): MTI = 0.22-0.3 prior to irradiation and MTI (0.3. Mediastinal nodes showed complete regression immediately after therapy (34-49 Gy aimed at mediastinum) in 12.3% only. In 44 patients (67.6%), complete response was not observed until 3-6 months after treatment, sometimes 24 months. Tumor recurred outside area of exposure 2-4 years in 4 (10.8%) in group I and 2 (7%) in group II (p(3.841). No correlation between recurrence rates and intrathoracic lymph node size was established. 10-year survival in both groups was 89.1 and 92.8%, respectively.
Subject(s)
Hodgkin Disease/pathology , Hodgkin Disease/radiotherapy , Lymph Nodes/pathology , Adult , Female , Humans , Lymphatic Metastasis , Male , Mediastinum , Middle Aged , Neoplasm Staging , Radiotherapy Dosage , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
A study is presented of second malignancies detected after treatment for Hodgkin's disease in 942 patients treated at the Institute's Clinic (1973-1993). Solid tumors were diagnosed, generally, during long complete remission, both after chemoradiation or radiotherapy (2.2 and 1.3%, respectively, p > 0.1). Yet, second tumor incidence tended to increase after combination treatment. Intestinal tumors were the most frequent. Tumors did not arise necessarily at sites which had been irradiated. Total doses absorbed by involved organs varied from 4-7 to 24-44 Gy, thus implying that absolute values of such doses did not correlate directly with risk of solid tumor development; the same was true for size of exposure fields. Dose distribution in time is of particular interest: there were no tumors among those treated with accelerated multifractionated irradiation. If radiotherapy procedures are improved and individual schedules of fractionated irradiation are used, the probability of solid tumor incidence, which, after radiotherapy of Hodgkin's disease, is not very high, can be still lowered.
