Impact of adjuvant radiation on the patterns and rate of relapse in advanced-stage Hodgkin's disease treated with alternating chemotherapy combinations Journal Article
| Authors: | Yahalom, J.; Ryu, J.; Straus, D. J.; Gaynor, J. J.; Myers, J.; Caravelli, J.; Clarkson, B. D.; Fuks, Z. |
| Article Title: | Impact of adjuvant radiation on the patterns and rate of relapse in advanced-stage Hodgkin's disease treated with alternating chemotherapy combinations |
| Abstract: | The role of adjuvant radiation therapy (RT) in the management of advanced-stage Hodgkin's disease (HD) was analyzed in 222 patients who attained a complete remission (CR) with alternating chemotherapy combinations. Mechlorethamine, vincristinc, procarbazine, and prednisone/doxorubicin, bleomycin, vinblastine, and dacarbazine (MOPP/ABVD) or MOPP/ ABV alternating with the lomustine, melphalan, and vindesine combination (MOPP/ABV/CAD) were similarly effective in inducing a CR in 222 of 270 (83%) patients. These patients were scheduled to receive consolidative RT to bulky disease or other critical sites of initial nodal involvement to a total dose of 2,000 cGy, with an optional additional boost of 1,000 cGy. However, only 125 (56%) patients received radiation to all initial nodal sites of disease. In 69 (31%) patients, only selected nodal sites were included in the radiation fields, and 28 (13%) did not receive any RT. Of the 222 CR patients, 42 (19%) relapsed during a median follow-up period of 6.5 years (range, 2 to 15 years). Of these, 26 (62%) patients relapsed exclusively in unirradiated nodal sites, six (14%) within irradiated sites, and 10 (24%) both within and outside irradiated fields. The actuarial 10-year relapse-free survival (RFS) and overall survival (OS) for patients receiving radiation to all initially involved nodal sites were 89% and 94%, respectively, compared with 68% and 71% (P < .0001) for patients who had only partial or no RT. Cox proportional hazards regression analysis showed that RT to all sites of initial disease was the most significant independent covariate (P < .005) affecting RFS and OS. These data demonstrate that residual microscopic disease is relatively frequent in patients with apparent CR after alternating combination chemotherapy, and that irradiation of all sites of initial nodal involvement decreases relapse and improves survival in advancedstage HD. © 1991 by American Society of Clinical Oncology. |
| Keywords: | survival; adult; survival analysis; major clinical study; prednisone; doxorubicin; advanced cancer; combined modality therapy; follow-up studies; neoplasm staging; dacarbazine; antineoplastic combined chemotherapy protocols; proportional hazards models; recurrence; melphalan; vincristine; chlormethine; lomustine; procarbazine; vinblastine; hodgkin disease; remission induction; bleomycin; vindesine; middle age; actuarial analysis; human; priority journal; article; support, non-u.s. gov't |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 9 |
| Issue: | 12 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 1991-12-01 |
| Start Page: | 2193 |
| End Page: | 2201 |
| Language: | English |
| DOI: | 10.1200/jco.1991.9.12.2193 |
| PUBMED: | 1960560 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 27 September 2019 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work