-
1. Mauch PM, Armitage JO, Diehl V, et al., eds. Hodgkin's disease. Philadelphia: Lippincott Williams & Wilkins, 1999.
Google Scholar -
2. Carde P, Burgers JM, Henry-Amar M, et al. Clinical stages I and II Hodgkin's disease: a specifically tailored therapy according to prognostic factors. J Clin Oncol 1988;6:239-252
Google Scholar -
3. Specht L, Gray RG, Clarke MJ, Peto R. Influence of more extensive radiotherapy and adjuvant chemotherapy on long-term outcome of early-stage Hodgkin's disease: a meta-analysis of 23 randomised trials involving 3,888 patients. J Clin Oncol 1998;16:830-843
Google Scholar -
4. Boivin JF, Hutchinson GB, Zauber AG, et al. Incidence of second cancers in patients treated for Hodgkin's disease. J Natl Cancer Inst 1995;87:732-741
Google Scholar -
5. van Leeuwen FE, Klokman WJ, van't Veer MB, et al. Long-term risk of second malignancy in survivors of Hodgkin's disease treated during adolescence or young adulthood. J Clin Oncol 2000;18:487-497
Google Scholar -
6. Ng AK, Bernardo MP, Weller E, et al. Long-term survival and competing causes of death in patients with early-stage Hodgkin's disease treated at age 50 or younger. J Clin Oncol 2002;20:2101-2108
Google Scholar -
7. Specht L. Very long-term follow-up of the Danish National Hodgkin Study Group's randomized trial of radiotherapy (RT) alone vs. combined modality treatment (CMT) for early stage Hodgkin lymphoma, with special reference to second tumors and overall survival. Blood 2003;102:Suppl:2351a-2351a
Google Scholar -
8. Franklin J, Pluetschow A, Paus M, et al. Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomized trials. Ann Oncol 2006;17:1749-1760
Google Scholar -
9. Bonadonna G, Zucali R, Monfardini S, De Lena M, Uslenghi C. Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, imidazole carboxamide versus MOPP. Cancer 1975;36:252-259
Google Scholar -
10. Engert A, Franklin J, Eich HT, et al. Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favourable Hodgkin's lymphoma: final results of the GHSG HD7 Trial. J Clin Oncol 2007;25:3495-3502
Google Scholar -
11. Ferme C, Eghbali H, Meerwaldt JH, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med 2007;357:1916-1927
Google Scholar -
12. Noordijk EM, Carde P, Dupouy N, et al. Combined-modality therapy for clinical stage I or II Hodgkin's lymphoma: long-term results of the European Organisation for Research and Treatment of Cancer H7 randomized controlled trials. J Clin Oncol 2006;24:3128-3135
Google Scholar -
13. Engert A, Schiller P, Josting A, et al. Involved-field radiotherapy is equally effective and less toxic as compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavourable Hodgkin's lymphoma: results of the HD8 trial of the German Hodgkin's Lymphoma Study Group (GHSG). J Clin Oncol 2003;21:3601-3608
Google Scholar -
14. NCCN clinical practice guidelines in oncology: Hodgkin disease/lymphoma. Fort Washington, PA: National Comprehensive Cancer Network, 2008. (Available at http://www.nccn.org.)
Google Scholar -
15. Straus DJ, Portlock CS, Oin J, et al. Results of a prospective randomized clinical trial of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy (RT) versus ABVD alone for stages I, II and IIIA non-bulky Hodgkin disease. Blood 2004;104:3483-3489
Google Scholar -
16. Connors JM. State-of-the-art therapeutics: Hodgkin's lymphoma. J Clin Oncol 2005;23:6400-6408
Google Scholar -
17. Canellos GP. Chemotherapy alone for early Hodgkin's lymphoma: an emerging option. J Clin Oncol 2005;23:4574-4576
Google Scholar -
18. Yahalom J. Don't throw out the baby with the bathwater: on optimizing cure and reducing toxicity in Hodgkin's lymphoma. J Clin Oncol 2006;24:544-548
Google Scholar -
19. Nachman JB, Posto R, Herzog P, et al. Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin's disease who achieve a complete response to chemotherapy. J Clin Oncol 2002;20:3765-3771
Google Scholar -
20. Bloomfield CD, Pajak TF, Glicksman AS, et al. Chemotherapy and combined modality therapy for Hodgkin's disease: a progress report on Cancer and Leukemia Group B studies. Cancer Treat Rep 1982;66:835-846
Google Scholar -
21. Pavlovsky S, Maschio M, Santarelli MT, et al. Randomized trial of chemotherapy versus chemotherapy plus radiotherapy for stage I-II Hodgkin's disease. J Natl Cancer Inst 1988;80:1466-1473
Google Scholar -
22. Aviles A, Delgado S. A prospective clinical trial comparing chemotherapy, radiotherapy and combined therapy in the treatment of early stage Hodgkin's disease with bulky disease. Clin Lab Haematol 1998;20:95-99
Google Scholar -
23. Meyer RM, Gospodarowicz MK, Connors JM, et al. Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol 2005;23:4634-4642
Google Scholar -
24. Eghbali H, Brice P, Creemers GY, et al. Comparison of three radiation dose levels after EBVP regimen in favourable supradiaphragmatic clinical stages (CS) I-II Hodgkin's lymphoma (HL): preliminary results of the EORTC-GELA H9-F Trial. Blood 2005;106:Suppl:814a-814a
Google Scholar -
25. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease. N Engl J Med 1998;339:1506-1514
Google Scholar -
26. Hutchings M, Loft A, Hansen M, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 2006;107:52-59
Google Scholar -
27. Kobe C, Dietlein M, Franklin J, et al. Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma. Blood 2008;112:3989-3994
Google Scholar -
28. Spaepen K, Stroobants S, Dupont P, et al. Can positron emission tomography with -fluorodeoxyglucose after first-line treatment distinguish Hodgkin's disease patients who need additional therapy from others in whom additional therapy would mean avoidable toxicity? Br J Haematol 2001;115:272-278
Google Scholar -
29. Zinzani PL, Tani M, Fanti S, et al. Early positron emission tomography (PET) restaging: a predictive final response in Hodgkin's disease patients. Ann Oncol 2006;17:1296-1300
Google Scholar -
30. Gallamini A, Hutchings M, Rigacci L, et al. Early interim 2--fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 2007;25:3746-3752
Google Scholar
14 augustus 2010: Bron: N Engl J Med. 2010;363:640-652, 653-662.
Minder vaak en minder intensieve bestraling van beginnende lymfklierkanker na chemo geeft zelfde resultaat op ziektevrije tijd en overall overleving maar met minder ernstige bijwerkingen. Mensen met een beginnende vorm van lymfklierkanker - Hodgkin lymfoom, blijken standaard te intensief te worden behandeld met radiotherapie (bestraling) na chemo met het verhoogde risico dat zij op latere leeftijd andere vormen van kanker krijgen en ook ernstig hartfalen. (zie o.a. studie uit 2003 die dit aantoont). Dit blijkt uit een langjarige gerandomiseerde fase III studie en gepubliceerd in N Engl J Med.
Het volledige studierapport: Reduced Treatment Intensity in Patients with Early-Stage Hodgkin's Lymphoma
is gratis in te zien. Onderaan artikel staat abstract plus referentielijst
Ziektevrije overleving vergelijkbaar
De onderzoekers onderzochten 1270 patiënten, gerandomiseerd ingedeeld in vier groepen, met nieuw gediagnosticeerde lymfklierkanker - Hodgkin lymfoom en een gunstige prognose: 4 of 2 cycli van chemo (ABVD) gevolgd door radiotherapie met 30 GY of 20 Gy (tabel 1).
Table 1: Reduced Treatment Intensity in Early Hodgkin's Lymphoma
| Treatment | Group 1 | Group 2 | Group 3 | Group 4 |
| ABVD (cycles) | 4 | 4 | 2 | 2 |
| Radiation dose (Gy) | 30 | 20 | 30 | 20 |
ABVD doses: 25 mg/m2 ofdoxorubicin, 10 mg/m2 of bleomycin, 6 mg/m2 of vinblastine, and 375 mg/m2 of dacarbazine
De onderzoekers rapporteren dat patienten in alle 4 de groepen een uitstekend resutlaat letien zien wat betreft ziektevrije tijd en overall overleving na 5 jaar. Na 5 jaar, was de ziektevrije overleving 93% met 4 cycli van ABVD en 91,1% met 2 cycli. Er waren geen significante verschillen in de algehele overleving tussen de 30 Gy en 20 Gy stralingsdoses.
Zoals verwacht, hadden patiënten die 4 cycli van de ABVD hadden gekregen meer bijwerkingen en acute behandelings gerelateerde toxiciteit dan degenen die 2 cycli hadden gekregen (graad 3 of 4 toxiciteit: 51,7% vs 33,2%).
De auteurs concluderen dat "bij patiënten met een lymfoom in een vroeg stadium van Hodgkin en een gunstige prognose, behandeling met 2 cycli van ABVD gevolgd door bestraling met 20 Gy, net zo effectief is en minder toxisch dan 4 cycli van de ABVD gevolgd door bestraling met 30 Gy"
Maar zij waarschuwen dat "gezien het feit dat veel van de late, fatale complicaties van de bestraling pas ontstaan in het tweede decennium na de behandeling, onze gegevens niet kunnen worden gebruikt om het effect van de behandeling op de totale overleving te meten."
"De volgende vraag is of radiotherapie kan worden weggelaten na 2 of 3 cycli van ABVD bij patiënten die [positron emissie tomografie]-negatief zijn. Wij en de [European Organization for Research on Cancer Treatment] voeren grote klinische trials uit om deze vraag te beantwoorden , "zei Dr Engert.
Citaat uit commentaar van Medscape waar u hier het volledige verslag kunt lezen:
The researchers report that all 4 regimens produced similar freedom from treatment failure and overall survival. At 5 years, failure-free survival rates were 93% with 4 cycles of ABVD and 91.1% with 2 cycles. There were no significant differences in freedom from treatment failure or overall survival between the 30 Gy and 20 Gy radiation doses.
As expected, patients who had 4 cycles of ABVD had more adverse events and acute treatment-related toxicity than those who had 2 cycles (grade 3 or 4 toxicity: 51.7% vs 33.2%).
The authors conclude that "in patients with early-stage Hodgkin's lymphoma and a favorable prognosis, treatment with 2 cycles of ABVD followed by 20 Gy of involved-field radiation therapy is as effective as, and less toxic than, 4 cycles of ABVD followed by 30 Gy of involved-field radiation therapy."
However, they caution that "given that many of the late, fatal complications of radiation therapy do not emerge until the second decade after treatment, our data cannot speak to the effect of treatment on overall survival."
"The next question is whether radiotherapy can be omitted after 2 or 3 cycles of ABVD in patients who are [positron emission tomography]-negative. We and the [European Organization for Research on Cancer Treatment] are running large clinical trials to answer this question," Dr. Engert said.
In patients with early-stage Hodgkin's lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy is as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy.
Reduced Treatment Intensity in Patients with Early-Stage Hodgkin's Lymphoma
Abstract
Background
Whether it is possible to reduce the intensity of treatment in early (stage I or II) Hodgkin's lymphoma with a favorable prognosis remains unclear. We therefore conducted a multicenter, randomized trial comparing four treatment groups consisting of a combination chemotherapy regimen of two different intensities followed by involved-field radiation therapy at two different dose levels.
Methods
We randomly assigned 1370 patients with newly diagnosed early-stage Hodgkin's lymphoma with a favorable prognosis to one of four treatment groups: four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy of radiation therapy (group 1), four cycles of ABVD followed by 20 Gy of radiation therapy (group 2), two cycles of ABVD followed by 30 Gy of radiation therapy (group 3), or two cycles of ABVD followed by 20 Gy of radiation therapy (group 4). The primary end point was freedom from treatment failure; secondary end points included efficacy and toxicity of treatment.
Results
The two chemotherapy regimens did not differ significantly with respect to freedom from treatment failure (P=0.39) or overall survival (P=0.61). At 5 years, the rates of freedom from treatment failure were 93.0% (95% confidence interval , 90.5 to 94.8) with the four-cycle ABVD regimen and 91.1% (95% CI, 88.3 to 93.2) with the two-cycle regimen. When the effects of 20-Gy and 30-Gy doses of radiation therapy were compared, there were also no significant differences in freedom from treatment failure (P=1.00) or overall survival (P=0.61). Adverse events and acute toxic effects of treatment were most common in the patients who received four cycles of ABVD and 30 Gy of radiation therapy (group 1).
Conclusions
In patients with early-stage Hodgkin's lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy is as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy. Long-term effects of these treatments have not yet been fully assessed. (Funded by the Deutsche Krebshilfe and the Swiss Federal Government; ClinicalTrials.gov number, NCT00265018.)
References (30)
Gerelateerde artikelen
- Fludarabine-melfalan (Flu-Mel140) voorafgaand aan allogene stamceltransplantatie voor patienten met non-Hodgkin geeft hoger sterfterisico vergeleken met fludarabine-intraveneuze busulfan
- Bendamustine plus Rituximab gevolgd door behandelingen met 90-Yttrium plus 4x Ibritumomab Tiuxetan voor onbehandelde Folliculaire Lymfomen geeft betere overall overleving en langere duurzame ziektevrije tijd
- Behandeling met 1 medicijn is effectiever (CR: 41 vs 19 procent) dan combinatie van medicijnen bij agressieve vorm van lymfklierkanker (Peripheral T-cell Lymphoma).
- Lenalidomide naast rituximab verbetert mediane progressievrije overleving met 25 maanden (39 vs 14 maanden) bij patienten met recidief van indolente lymfomen - lymfklierkanker, in vergelijking met alleen rituximab copy 1
- DNA mutaties: In bloed circulerende tumor DNA metingen geven vooraf en al na 1 behandeling een uitstekende prognose op de uiteindelijke effectiviteit van een behandeling van zogeheten diffuus grootcellig lymfoom - B-Cell Lymfklierkanker
- Ibrutinib aanvullend op Bendamustine en Rituximab verbetert progressievrije ziekte en overall overleving met tientallen procenten bij Chronische Lymfatische Leukemia en recidief van lymfklierkanker met kleine tumoren
- Bendamustine plus rituximab (Rituxin) geeft verdubbeling van ziektevrije tijd, betere overleving met minder bijwerkingen voor patiënten met nieuw gediagnosticeerde lymfklierkanker - non-Hodgkin en mantelcellymfomen, in vergelijking met de R-CHOP kuren
- Chemo en bestraling: 2x bestralen na 2x chemo bij lymfklierkanker - Hodgkin lymfoom geeft zelfde resultaat op ziektevrije tijd en recidiefkansen als 4x bestralen, maar veel minder kans op ernstige bijwerkingen en latere complicaties.
- Chemo: Een combinatiebehandeling van Fludarabine, cyclophosphamide, en rituximab geeft significant betere resultaten op tijd tot progressie van de ziekte en op overleving bij non-Hodgkin en CLL - Chronische Lymfatische Leukemie.
- chemo combinatie doxorubicin, cyclophosphamide, vindesine, bleomycin, en prednisone (ACVBP) geeft significant betere resultaten, langere overlevingstijd, dan de chemocombinatie cyclophosphamide, doxorubicin, vincristine
- Chemo en effect bij mantelcel lympfomen: Met een aanpak van eerst een eenmalige toediening van Rituximab plus cyclophosphamide, vincristine, doxorubicin en dexamethason (hyper CVAD) gevolgd door Rituximab plus hoge dosis methotrexate-cytarabine worden hog
- Chemo en effect bij lymfklierkanker: Rituximab - Mabthera toegevoegd aan CHOP behandeling bij lymfeklierkanker - B-cel lympfomen geeft superieure resultaten blijkt uit gerandomiseerde fase III studie.
- Chemo en effect bij lymfklierkanker: Patiënten met ziekte van Hodgkin gebaat bij nieuwe chemomix - BEACOPP met verhoogde dosis - en niet gebaat bij aanvullende radiotherapie/bestraling na chemo aldus twee gerandomiseerde langjarige studies. copy 1
- Chemo en bestraling voor lymfklierkanker - Non-Hodgkin en ziekte van Hodgkin - geeft groot risico op latere nieuwe vormen van kanker. Bij jonge vrouwen 136 keer grotere kans op borstkanker bv. aldus studieverslagen in de Lancet.
- Mabthera - Rituximab - Rituxan blijkt beste aanpak voor lymfklierkanker: enkele studies bij elkaar gezet
- Chemo en effecten bij lymfklierkanker: een overzicht van ontwikkelingen binnen reguliere oncologie van afgelopen tien jaar
Plaats een reactie ...
Reageer op "Chemo en bestraling: 2x bestralen na 2x chemo bij lymfklierkanker - Hodgkin lymfoom geeft zelfde resultaat op ziektevrije tijd en recidiefkansen als 4x bestralen, maar veel minder kans op ernstige bijwerkingen en latere complicaties."