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1.
Lancet Oncol ; 10(12): 1160-70, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19828373

RESUMO

BACKGROUND: Little is known about the longitudinal course of health-related quality of life (HRQoL) in patients with Hodgkin's lymphoma during their post-treatment follow-up and re-adaptation to normal life. We report on the HRQoL of patients treated in the randomised H8 trial of the European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and the Groupe d'Etudes des Lymphomes de l'Adulte (GELA). We aimed to assess HRQoL and fatigue following treatment, to analyse relations with treatment, and to identify factors that predict persistent fatigue. METHODS: Patients received HRQoL questionnaires at the end of primary therapy and during follow-up. The EORTC QLQ-C30 was used to assess HRQoL, and the Multidimensional Fatigue Inventory (MFI-20) was used to assess fatigue. Changes of mean HRQoL scores over time were analysed with mixed models. Multiple polytomic nominal logistic regression was done to identify independent baseline predictors of fatigue within MFI-20 dimensions. Analyses were done on an intention-to-treat basis. This study is registered with www.ClinicalTrials.gov, number NCT00379041. FINDINGS: 2666 assessments from 935 patients were analysed. Mean follow-up was 90 months (range 52-118). Age affected all functioning and symptom scores except emotional functioning, with younger age associated with higher functioning and lower severity of symptoms; improvement with time showed similar patterns between age groups. Women reported lower HRQoL and higher symptom scores than did men. Overall, 3.2% (14/439 for role functioning) to 9.7% (43/442 for social functioning) and 5.8% (29/498 for reduced motivation) to 9.9% (49/498 for general fatigue) of patients reported impairments of 10 points or more (on a 0-100 scale) in QLQ-C30 and MFI-20 scores, respectively, independent of age and sex. Emotional domains were more affected than physical ones. There was no relation between HRQoL outcome and type of treatment. Fatigue (MFI-20 scores) at the end of treatment was the only predictive variable for persistent fatigue, with odds ratios varying from 2.58 (95% CI 1.00-6.67) to 41.51 (12.02-143.33; p

Assuntos
Doença de Hodgkin/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Doença de Hodgkin/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
2.
N Engl J Med ; 357(19): 1916-27, 2007 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-17989384

RESUMO

BACKGROUND: Treatment of early-stage Hodgkin's disease is usually tailored in line with prognostic factors that allow for reductions in the amount of chemotherapy and extent of radiotherapy required for a possible cure. METHODS: From 1993 to 1999, we identified 1538 patients (age, 15 to 70 years) who had untreated stage I or II supradiaphragmatic Hodgkin's disease with favorable prognostic features (the H8-F trial) or unfavorable features (the H8-U trial). In the H8-F trial, we compared three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) combined with doxorubicin, bleomycin, and vinblastine (ABV) plus involved-field radiotherapy with subtotal nodal radiotherapy alone (reference group). In the H8-U trial, we compared three regimens: six cycles of MOPP-ABV plus involved-field radiotherapy (reference group), four cycles of MOPP-ABV plus involved-field radiotherapy, and four cycles of MOPP-ABV plus subtotal nodal radiotherapy. RESULTS: The median follow-up was 92 months. In the H8-F trial, the estimated 5-year event-free survival rate was significantly higher after three cycles of MOPP-ABV plus involved-field radiotherapy than after subtotal nodal radiotherapy alone (98% vs. 74%, P<0.001). The 10-year overall survival estimates were 97% and 92%, respectively (P=0.001). In the H8-U trial, the estimated 5-year event-free survival rates were similar in the three treatment groups: 84% after six cycles of MOPP-ABV plus involved-field radiotherapy, 88% after four cycles of MOPP-ABV plus involved-field radiotherapy, and 87% after four cycles of MOPP-ABV plus subtotal nodal radiotherapy. The 10-year overall survival estimates were 88%, 85%, and 84%, respectively. CONCLUSIONS: Chemotherapy plus involved-field radiotherapy should be the standard treatment for Hodgkin's disease with favorable prognostic features. In patients with unfavorable features, four courses of chemotherapy plus involved-field radiotherapy should be the standard treatment. (ClinicalTrials.gov number, NCT00379041 [ClinicalTrials.gov].).


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/radioterapia , Irradiação Linfática , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/administração & dosagem , Terapia Combinada , Doxorrubicina/administração & dosagem , Feminino , Doença de Hodgkin/mortalidade , Humanos , Masculino , Mecloretamina/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Radioterapia/efeitos adversos , Indução de Remissão , Análise de Sobrevida , Vimblastina/administração & dosagem , Vincristina/administração & dosagem
3.
Acta Oncol ; 46(2): 172-80, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17453365

RESUMO

A study of the possible difference in outcome for positive margins for invasive carcinoma (IC) versus ductal carcinoma in situ (DCIS), and with regard to different age categories in a large prospective cohort of patients with invasive breast cancer. A total of 2 291 BCT were analyzed. Margins were positive for IC in 8.7% and for DCIS in 4.6%. The median follow-up was 83 months. The 10-year local recurrence-free survival for negative margins vs. positive margins for IC vs. positive for DCIS for women < or = 40 years were 84.4% vs. 34.6% (HR 4.5) vs. 67.5%, and for women >40 years 94.7% vs. 92.6% vs. 82.6% (HR4.2). The 10-year distant disease-free survival for negative margins vs. positive margins for IC vs. positive for DCIS women < or = 40 years were 72.0% vs. 39.7% (HR 3.4) vs. 77.8%. The disease-specific survival showed a significant relation to positive margins for IC in young women. The effect of positive margin for IC seems to be limited to young women only, and is not only restricted to local control, but also to distant metastasis and survival. On the other hand a positive margin for DCIS is a risk factor for local control in women >40 years.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Carcinoma/terapia , Adulto , Carcinoma/mortalidade , Carcinoma/secundário , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Estudos Longitudinais , Invasividade Neoplásica , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Análise de Sobrevida
4.
Haematologica ; 91(11): 1481-8, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17043014

RESUMO

BACKGROUND AND OBJECTIVES: Second cancer has been associated with non-Hodgkin's Lymphoma (NHL) treatment, but few studies have addressed this issue considering specific treatments. DESIGN AND METHODS: We estimated risk by standardized incidence ratios (SIR) and absolute excess risk (AER) based on general population rates (European Network of Cancer Registries) in 748 patients (aged 15-82 years) treated for aggressive NHL in four successive EORTC (European Organization for Research on Treatment of Cancer) trials. RESULTS: All patients received fully-dosed CHOP-like chemotherapy, 65% received involved-field radiotherapy and 14% high-dose treatment. Half of the patients needed salvage treatment and 37% were followed for more than 10 years. The cause of death was NHL in 79% of the patients; 4% died of second cancer (median survival 8.9 (0.8- 20.5) years). Cumulative incidences (death from any cause being a competing event) were 5% and 11% for solid cancer and 1% and 3% for acute myeloid leukemia/myelodysplastic syndrome at 10 and 15 years, respectively. Cancer risk appeared age-related: in young patients high risks were observed for leukemia (SIR 16.7,95% CI 1.4-93.1,AER 5.0), Hodgkin's lymphoma (SIR 60.1,95% CI 12.4-175.2, AER 15.7), colorectal cancer (SIR 12.5, 95% CI 2.6-36.5, AER 14.7) and lung cancer (SIR 15.4; 95% CI 4.2-39.4, AER 19.8), while risk in patients older than 45 years matched than that in the normal population. The risk of cancer was significantly raised by smoking and salvage treatment. INTERPRETATION AND CONCLUSIONS: Half of the patients die of aggressive NHL before living long enough to experience second cancer. Only young patients have a high risk of second cancer during follow-up beyond 10 years.


Assuntos
Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estudos de Coortes , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Doxorrubicina/efeitos adversos , Doxorrubicina/uso terapêutico , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/induzido quimicamente , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Vincristina/efeitos adversos , Vincristina/uso terapêutico
5.
Int J Radiat Oncol Biol Phys ; 66(4): 1168-77, 2006 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-16887289

RESUMO

PURPOSE: Whether salvage therapy in patients with advanced aggressive non-Hodgkin's lymphoma (NHL) in partial remission (PR) should consist of radiotherapy or autologous stem-cell transplantation (ASCT) is debatable. We evaluated the impact of radiotherapy on outcome in PR patients treated in four successive European Organization for Research and Treatment of Cancer trials for aggressive NHL. PATIENTS AND METHODS: Records of 974 patients (1980-1999) were reviewed regarding initial response, final outcome, and type and timing of salvage treatment. After 8 cycles of doxorubicin-based chemotherapy, 227 NHL patients were in PR and treated: 114 received involved field radiotherapy, 16 ASCT, 93 second-line chemotherapy, and 4 were operated. Overall survival (OS) and progression-free survival (PFS) after radiotherapy were estimated (Kaplan-Meier method) and compared with other treatments (log-rank). Impact on survival was evaluated by multivariate analysis (Cox proportional hazards model). RESULTS: The median PFS in PR patients was 4.2 years and 48% remained progression-free at 5 years. Half of the PR patients converted to a complete remission. After conversion, survival was comparable to patients directly in complete remission. Radiotherapy resulted in better OS and PFS compared with other treatments, especially in patients with low to intermediate International Prognostic Index score, bulky disease, or nodal disease only. Correction by multivariate analysis for prognostic factors such as stage, bulky disease, and number of extranodal locations showed that radiotherapy was clearly the most significant factor affecting both OS and PFS. CONCLUSION: This retrospective analysis demonstrates that radiotherapy can be effective for patients in PR after fully dosed chemotherapy; assessment in a randomized trial (radiotherapy vs. ASCT) is justified.


Assuntos
Doxorrubicina/uso terapêutico , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/terapia , Radioterapia Conformacional/mortalidade , Medição de Risco/métodos , Terapia de Salvação/mortalidade , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Intervalo Livre de Doença , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Radioterapia Adjuvante/mortalidade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
6.
Breast Cancer Res Treat ; 99(3): 289-94, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16596325

RESUMO

PURPOSE: To look at the optimum timing of radiotherapy in breast-conserving therapy (BCT) in relation to outcome in breast cancer. METHODS: We analyzed 1473 BCT on 1446 breast cancer patients from our prospective cohort, stage I or II, node-negative, and without adjuvant systemic therapy. Timing was defined as time from lumpectomy till radiotherapy. Patients were categorized into three timing tertiles: 1-36 days, 37-53 days, and 54-112 days. RESULTS: The 10-year local relapse-free survival rates did not show significant differences between the three groups. The 10-year Distant Metastasis-Free Survival (DMFS) was 78.9% for the first tertile, versus 86.1% (HR 0.6; P = 0.009) for the second, and 90.7% (HR 0.3; P < 0.001) for the third. The 10-year Disease-specific Survival (DSS) was 83.8% for the first tertile, versus 90.6% (HR 0.5; P = 0.007) for the second, and 97.2% (HR 02; P < 0.001) for the third. Also in multivariate Cox regression analysis the second (HR 0.6; P = 0.053) and the third tertile (HR 0.3; P = 0.002) had significantly better DSS. CONCLUSION: Timing of radiotherapy in BCT for breast cancer seems to be highly important in relation to survival. This study shows a 40-70% relative survival benefit with timing after 36 days.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mastectomia Segmentar , Recidiva Local de Neoplasia/prevenção & controle , Adulto , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Invasividade Neoplásica , Modelos de Riscos Proporcionais , Estudos Prospectivos , Radioterapia Adjuvante/métodos , Fatores de Tempo
7.
Blood ; 107(7): 2912-9, 2006 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-16339404

RESUMO

Cardiovascular disease frequently occurs after lymphoma therapy, but it is common in the general population too. Therefore, risk estimation requires comparison to population-based rates. We calculated risk by standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10,000 person-years based on general population rates (Continuous Morbidity Registry Nijmegen) in 476 (Dutch and Belgian) patients with aggressive non-Hodgkin lymphoma (NHL) treated with at least 6 cycles of doxorubicin-based chemotherapy in 4 European Organization for Research on Treatment of Cancer (EORTC) trials (1980-1999). Cumulative incidence of cardiovascular disease, estimated in a competing risk model, was 12% at 5 years and 22% at 10 years (median follow-up, 8.4 years). Risk of chronic heart failure appeared markedly increased (SIR, 5.4; 95% CI, 4.1-6.9) with an AER of 208 excess cases per 10 000 person-years, whereas risk of coronary artery disease matched the general population (SIR, 1.2; 95% CI, 0.8-1.8; AER, 8 per 10 000 person-years). Risk of stroke was raised (SIR, 1.8; 95% CI, 1.1-2.4; AER, 15 per 10 000 person-years), especially after additional radiotherapy (> 40 Gy). Preexisting hypertension, NHL at young age, and salvage treatment increased risk of all cardiovascular events; the effect of radiotherapy was dose dependent. In conclusion, patients are at long-term high risk of chronic heart failure after NHL treatment and need therefore life-long monitoring. In contrast, risk of coronary artery disease appeared more age dependent than treatment related.


Assuntos
Doenças Cardiovasculares/etiologia , Linfoma não Hodgkin/complicações , Estudos de Coortes , Doença das Coronárias/epidemiologia , Bases de Dados Factuais , Seguimentos , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Linfoma não Hodgkin/radioterapia , Países Baixos/epidemiologia , Radioterapia/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
8.
Clin Lymphoma Myeloma ; 6(2): 122-30, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16231850

RESUMO

BACKGROUND: A significant proportion of patients with aggressive non-Hodgkin's lymphoma (NHL) become long-term survivors. A European Organisation for Research and Treatment of Cancer database of patients with aggressive NHL, consistently treated with doxorubicin-based chemotherapy since 1980, afforded the possibility to explore late complications in this patient group. PATIENTS AND METHODS: Of 951 randomized patients, complete data on late complications could be collected in 757 patients who were alive > or = 2 years after the start of therapy and were seen at yearly follow-ups (median follow-up, 9.4 years; range, 2.1-20.4 years). We computed cumulative incidences of late events in a competing risk model by Gray (death being the competing event) to avoid bias caused by the high percentage of NHL-related deaths. Risk factors were estimated in a Cox proportional-hazards model and also evaluated with the Gray test. RESULTS: Late non-neoplastic events were found in 46% of the 757 patients. At 15 years, the cumulative incidences of cardiac disease and infertility were 20% and 29%, respectively. Renal insufficiency (11%), acquired hypertension (8%), and disabling neuropathy (13%) were also frequent. Salvage treatment was a risk factor in most cases. Smoking, age > 50 years during treatment, and preexistent hypertension were the main risk factors for cardiovascular disease. In-field radiation therapy (RT) was related to hypothyroidism, lung fibrosis, hypertension, gastrointestinal toxicity, and renal insufficiency but not to cardiovascular events. Autologous stem cell transplantation and cisplatin- and MOPP (mechlorethamine/vincristine/procarbazine/prednisone)-containing therapies were associated with infertility and renal insufficiency. CONCLUSION: Altogether, almost half the patients with aggressive NHL experienced events addressed as late non-neoplastic complications. Salvage therapy, smoking, age > 50 years, and in-field RT are important risk factors.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Linfoma não Hodgkin/complicações , Terapia de Salvação/efeitos adversos , Transplante de Células-Tronco/efeitos adversos , Condicionamento Pré-Transplante/efeitos adversos , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Europa (Continente) , Feminino , Seguimentos , Humanos , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/terapia , Masculino , Mecloretamina/efeitos adversos , Mecloretamina/uso terapêutico , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Procarbazina/efeitos adversos , Procarbazina/uso terapêutico , Radioterapia/efeitos adversos , Fatores de Risco , Terapia de Salvação/mortalidade , Fumar/efeitos adversos , Sociedades Médicas , Transplante de Células-Tronco/mortalidade , Condicionamento Pré-Transplante/mortalidade , Transplante Autólogo , Vincristina/efeitos adversos , Vincristina/uso terapêutico
9.
Int J Radiat Oncol Biol Phys ; 63(4): 1184-90, 2005 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-15936157

RESUMO

PURPOSE: To evaluate the impact of the quality of involved-field radiotherapy (IFRT) on clinical outcome in patients with advanced Hodgkin's lymphoma (HL) in complete remission (CR) after six to eight cycles of mechlorethamine, vincristine, procarbazine, prednisone-doxorubicin, bleomycin, and vinblastine (MOPP-ABV) chemotherapy. METHODS AND MATERIALS: A retrospective review of clinical and radiologic data, radiation charts, simulator films, and megavoltage (MV) photographs was performed. IFRT consisted of 24 Gy to all initially involved nodal areas and 16-24 Gy to all initially involved extranodal sites. Major violations were defined as no or only partial irradiation of an originally involved area, or a total dose <90% of the prescribed dose. RESULTS: Of the 739 patients who were enrolled in the trial between 1989 and 2000, 57% achieved a CR; 152 of 172 patients randomized to IFRT actually received radiotherapy; and in 135 patients, quality control was performed. The overall major violation rate was 47%, predominantly concerning target volumes. The total dose was correct in 81% of the patients. After a median follow-up of 6.5 years, there was no difference in cumulative failure rate between patients with or without major violations. There was no relationship between incidence or site of relapse and major protocol violations. CONCLUSION: In advanced-stage HL patients in complete remission after six to eight cycles of MOPP-ABV, the outcome was not influenced by violation of the radiotherapy protocol.


Assuntos
Doença de Hodgkin/radioterapia , Controle de Qualidade , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Terapia Combinada , Doxorrubicina/administração & dosagem , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/patologia , Humanos , Irradiação Linfática/normas , Mecloretamina/administração & dosagem , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Dosagem Radioterapêutica , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Estudos Retrospectivos , Vimblastina/administração & dosagem , Vincristina/administração & dosagem
10.
Int J Radiat Oncol Biol Phys ; 57(3): 724-31, 2003 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-14529777

RESUMO

PURPOSE: To identify the importance of positive margins for invasive carcinoma on local control in patients treated with breast-conservative treatment (BCT). METHODS AND MATERIALS: A total of 1752 BCT with known margins were analyzed. Fifty-five patients had a second BCT, leaving 1697 patients for analysis. The margins were positive in 193/1752 BCT (11%). The median follow-up was 78 months. RESULTS: The 5- and 10-year local recurrence rates (LRR) were 3.1% and 6.9%, respectively, for negative margins vs. 5.6% and 12.2% for positive margins. A statistical interaction between age category and margin status was noted in relation to disease-free survival (DFS) and local relapse-free survival. The 5-year LRR for women < or =40 years was 8.4% for negative margins and 36.9% for positive margins (p = 0.005). In a multivariate analysis, a positive margin was significant. The 5-year LRR for women >40 years was 2.6% for negative and 2.2% for positive margins. The 5-year DFS for women 40 years was 84.3% for positive and 87.2% for negative margins. CONCLUSION: Women < or =40 years are a special category of patients in breast cancer. Women < or =40 years must have negative margins for invasive carcinoma when treated with BCT. Minimum surgery for an optimal cosmetic result followed by irradiation, even with microscopic positive margins for invasive carcinoma, yields excellent results with regard to local control in patients older than 40 years.


Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Mastectomia Segmentar , Adulto , Fatores Etários , Análise de Variância , Axila , Neoplasias da Mama/mortalidade , Terapia Combinada , Intervalos de Confiança , Intervalo Livre de Doença , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasia Residual , Estudos Prospectivos , Dosagem Radioterapêutica , Fatores de Tempo
11.
N Engl J Med ; 348(24): 2396-406, 2003 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-12802025

RESUMO

BACKGROUND: The use of involved-field radiotherapy after chemotherapy for advanced Hodgkin's lymphoma is controversial. METHODS: We randomly assigned patients with previously untreated stage III or IV Hodgkin's lymphoma who were in complete remission after hybrid chemotherapy with mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP-ABV) to receive either no further treatment or involved-field radiotherapy. Radiotherapy consisted of 24 Gy to all initially involved nodal areas and 16 to 24 Gy to all initially involved extranodal sites. Patients in partial remission were treated with 30 Gy to nodal areas and 18 to 24 Gy to extranodal sites. RESULTS: Of 739 patients, 421 had a complete remission; 161 of these patients were assigned to no further treatment, and 172 to involved-field radiotherapy. The median follow-up was 79 months. The five-year event-free survival rate was 84 percent in the group that did not receive radiotherapy and 79 percent in the group that received involved-field radiotherapy (P=0.35). The five-year overall survival rates were 91 and 85 percent, respectively (P=0.07). Among the 250 patients in partial remission after chemotherapy, the five-year event-free and overall survival rates were 79 and 87 percent, respectively. CONCLUSIONS: Involved-field radiotherapy did not improve the outcome in patients with advanced-stage Hodgkin's lymphoma who had a complete remission after MOPP-ABV chemotherapy. Radiotherapy may benefit patients with a partial response after chemotherapy.


Assuntos
Doença de Hodgkin/radioterapia , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Terapia Combinada , Doxorrubicina/administração & dosagem , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/mortalidade , Doença de Hodgkin/patologia , Humanos , Masculino , Mecloretamina/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Segunda Neoplasia Primária/epidemiologia , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Indução de Remissão , Análise de Sobrevida , Vimblastina/administração & dosagem , Vincristina/administração & dosagem
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