Reduced Combined Radiotherapy and Chemotherapy for Hodgkin’s Disease — Risk-Adapted Treatment Approach

  • M. Herold
  • G. Anger
  • K. Keinert
  • D. Höche
  • R. Kästner
  • K. Wutke
Conference paper
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 117)

Abstract

Over the past two decades major progress has been made in the treatment of Hodgkin’s disease. It may be held as an example of successful tumor therapy. But still today certain subgroups of patients with Hodgkin’s disease do not respond to treatment or relapse early after standard treatment programs. These are particularly patients with advanced disease (stages III B and IV), but also patients in limited stages of Hodgkin’s disease (stages I-III A) with the presence of risk factors. Such risk factors which influence outcome in patients with limited stages of Hodgkin’s disease adversely are:
  • Mediastinal bulky disease (diameter greater than one-third of chest diameter) (Prosnitz 1983; Hoppe 1985; Specht and Nissen 1986)

  • Extranodal (E) lesions (especially of the lung) (Prosnitz 1983; Rubin et al. 1986)

  • Constitutional (B) symptoms (Prosnitz 1983; Rubin et al. 1986; Crnkovich et al. 1986)

  • Extended abdominal disease (stage III2) (Desser et al. 1977; Prosnitz 1983; Mauch et al. 1985; Diehl et al. 1986)

  • An unfavorable histological subtype (LD, not classified) (Löffler 1982; Mauch et al. 1985)

Combined modality treatment proved to be very effective in the management of Hodgkin’s disease. However, full-dose radio- and chemotherapy bears an unacceptable risk of long-term complications such as second malignancies [especially acute nonlymphocytic leukemia (ANLL)] and permanent sterility (Coltman and Dickson 1982; Rubin et al. 1986; Bookman and Longo 1983). So it cannot be regarded as the treatment of choice in Hodgkin’s disease (Schmidt 1982).

Keywords

Toxicity Lymphoma Leukemia Neuropathy Oncol 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bookman MA, Longo DL (1983) Concomitant illness in patients treated for Hodgkin’s disease. Cancer Treat Rev 13: 77–111CrossRefGoogle Scholar
  2. Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M (1971) Report of the committee on Hodgkin’s disease staging classification. Cancer Res 31: 1860–1861PubMedGoogle Scholar
  3. Coltman CA, Dixon DO (1982) Second malignancies complicating Hodgkin’s disease: a Southwest Oncology Group 10-year follow up. Cancer Treat Rep 66: 1023–1033PubMedGoogle Scholar
  4. Crnkovich MJ, Hoppe RT, Rosenberg SA (1986) Stage II B Hodgkin’s disease: the Stanford experience. J Clin Oncol 4: 472–479PubMedGoogle Scholar
  5. De Lena M, Altomare E, Colluci G, Marzullo F, Timurian A (1986) Combined ABVD (3 cycles) and radiotherapy (RT) in Hodgkin’s disease. 14’ International Cancer Congress, Budapest 1: 443Google Scholar
  6. Desser RK, Golomb HM, Ultman JE, Ferguson DJ, Moran GM, Gian MC, Vardiman J, Miller B, Oetzel N, Sweet D, Lester EP, Kinzu JJ, Blough R (1977) Prognostic classification of Hodgkin’s disease in pathological stage III, based on anatomic considerations. Blood 49: 883–893PubMedGoogle Scholar
  7. Diehl V, Pfreundschuh M, Hauser FE, Löffler M, Rühl U, Brücher H, Georgii A, Miller E, Gerhartz H (1986) Zwischenergebnisse der Therapiestudien HD 1, HD 2 und HD 3 der deutschen Hodgkin-Studiengruppe. Med Klin 81: 1–6Google Scholar
  8. Gomez GA, Panahon AM, Stutzman U, Han T, Ozer H, Henderson ES (1983) Simultaneous low dose radiation (RT) and low dose chemotherapy (CT) in the treatment of stage IV Hodgkin’s disease. Proc Am Soc Clin Oncol 1: C 811Google Scholar
  9. Herold M, Anger G, Höche D, Kästner R (1987) Vorläufige Ergebnisse einer zyklisch alternierenden Chemotherapie ( CVPP/DBVCy) bei fortgeschrittenem Morbus Hodgkin. Med Klin 82: 345–349Google Scholar
  10. Hoppe RT (1985) The management of stage II Hodgkin’s disease with a large mediastinal mass: a prospective program emphasizing irradiation. Int J Radiat Oncol Biol Phys 11: 349–355PubMedCrossRefGoogle Scholar
  11. Koletsky AJ, Bertino JR, Farber LR, Prosnitz LR, Kapp DS, Fisher D, Portlock CS (1986) Second neoplasma in patients with Hodgkin’s disease following combined modality therapy–the Yale experience. J Clin Oncol 4: 311–317PubMedGoogle Scholar
  12. Löffler H (1982) Prognostische Faktoren als Indikator des Malignitätsgrades bei Leukämien und malignen Lymphomen. Verh Dtsch Ges Inn Med 88: 474–484Google Scholar
  13. Lukes RJ, Craver LF, Hale TC, Rappaport H, Ruben P (1966) Report of the nomenclature committee. Cancer Res 26: 1311Google Scholar
  14. Mauch P, Goffman T, Rosenthal DS, Canellos GP, Come SE, Hellman S (1985) Stage III Hodgkin’s disease: improved survival with combined modality therapy as compared with radiation therapy alone. J Clin Oncol 3: 1166–1173PubMedGoogle Scholar
  15. Prosnitz LR (1983) The role of combination chemotherapy alone or as an adjuvant to radiation therapy in limited stages of Hodgkin’s disease. In: Bennet JM (ed) Controversies in the management of lymphomas. Martinus Nijhoff, Boston, pp 151–166CrossRefGoogle Scholar
  16. Rubin P, Constine L, Bennet JM (1986) Hodgkin’s disease. IIB or not to be — using irradiation alone or in combination with chemotherapy? That is the questionl J Clin Oncol 4: 455–457PubMedGoogle Scholar
  17. Santoro A, Viviani S, Zucali R, Ragni G, Bonfante V, Valagussa P, Banfi A, Bonadonna G (1983) Comparative results and toxicity of MOPP vs. ABVD combined with radiotherapy in PS IIB, IIIA, B Hodgkin’s disease. Proc Am Soc Clin Oncol 2: C 872Google Scholar
  18. Schmidt CG (1982) Antwort zum Thema: Bei welchen Lymphomen und in welchen Stadien setzen Sie die kombinierte Chemo-Strahlentherapie unter kurativer Zielstellung in die primäre Behandlung ein? Med Welt 33: 196Google Scholar
  19. Specht L, Nissen NJ (1986) Prognostic significance of tumor burden in Hodgkin’s disease PS I and II. Scand J Haematol 36: 367–375PubMedCrossRefGoogle Scholar
  20. Straus DJ, Myers J, Lee BJ, Nisce CZ, Koziner B, McCormick B, Kempin S, Mertelsmann R, Arlin Z, Gee T, Poussin-Rosillo H, Hanson H, Clarkson BD (1984) Treatment of advanced Hodgkin’s disease with chemotherapy and irradiation. Am J Med 76: 270–278PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1989

Authors and Affiliations

  • M. Herold
    • 1
  • G. Anger
    • 1
  • K. Keinert
    • 1
  • D. Höche
    • 1
  • R. Kästner
    • 1
  • K. Wutke
    • 1
  1. 1.Klinik für Innere MedizinMedizinische Akademie ErfurtErfurtGDR

Personalised recommendations