Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease

New England Journal of Medicine (Impact Factor: 55.87). 03/2008; 358(7):742; author reply 743. DOI: 10.1056/NEJMc073375
Source: PubMed

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    • "This approach became standard practice in handling cancers in general in Uganda beyond BL (Olweny, 1980; Orem & Wabinga, 2009). The first report of efficacy of chemotherapy alone in treating childhood Hodgkin lymphoma came from the Institute; this was at the time when radiotherapy was the main modality in resource-rich countries for the management of early stage disease (Olweny et al, 1978; Olweny & Ziegler, 2008). A comprehensive description of adult and childhood endemic Kaposi sarcoma, response to treatment and early observation of epidemic form of the disease in Africa were made at the Institute (Olweny, 1984a). "
    [Show abstract] [Hide abstract] ABSTRACT: Burkitt lymphoma (BL) was first described in Uganda in 1958 as a sarcoma of the jaw but later confirmed to be a distinct form of Non Hodgkin lymphoma (NHL). This discovery was the defining moment of cancer research in Uganda, which eventually led to the establishment of a dedicated cancer research institute, the Uganda Cancer Institute (UCI) in 1967. The centre was dedicated to Denis Burkitt in recognition of his contribution to cancer research in East Africa. BL is still the commonest NHL in childhood in Uganda. Its incidence has significantly increased recently due to yet unknown factors. Although the human immunodeficiency virus (HIV) was considered a possible reason for the increase, there is no evidence that it has substantially impacted on the epidemiology of the disease. However, for those patients with BL who are co infected with HIV there is a clear impact of the disease on clinical presentation and outcome. HIV-infected patients commonly present with extra facial sites and tend to have poor overall survival (median survival of 11·79 months). In summary, BL, as a disease entity in Uganda, has maintained the same clinical characteristics since its discovery, despite the emergence of HIV during the intervening period.
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  • [Show abstract] [Hide abstract] ABSTRACT: Le traitement standard des stades I–II sus-diaphragmatiques est défini selon les facteurs de risque et comporte une chimiothérapie ABVD, trois cycles (patients sans facteur de risque) ou quatre cycles (patients avec facteurs de risque), suivis d’une irradiation des territoires ganglionnaires initialement atteints à la dose de 30 Gy. L’analyse finale des essais récents est attendue pour préciser la possibilité de réduire la dose d’irradiation à 20 Gy après réponse complète induite par la chimiothérapie. Un traitement par chimiothérapie exclusive n’est pas actuellement recommandé, en dehors des essais thérapeutiques en cours qui intègrent la TEP après deux cycles comme élément décisionnel d’un traitement sans radiothérapie. Les techniques modernes d’irradiation et d’imagerie sont développées pour réduire les volumes irradiés aux seuls ganglions initialement atteints. The risk-adapted therapeutic strategy used for adult patients with Hodgkin’s lymphoma is defined taking into account their risk factors and includes standard first-line ABVD chemotherapy. In early-stage supradiaphragmatic disease, 3 chemotherapeutic courses are applied for patients without risk factors while 4 courses are used for patients with risk factors, followed by a radiation therapy targeting initially involved fields (IFRT) at a dose of 30 Gy. Final analysis of the results of recent trials is expected to determine whether IFRT doses may be reduced to 20 Gy in patients showing chemotherapy-induced complete remission. Chemotherapy alone is not recommended currently, except in ongoing clinical trials in which positron emission tomography (PET) scans are used to evaluate the early response to chemotherapy without radiation. Modern radiation and imaging modalities are expected to permit the restriction of radiation-targeted volumes to initially involved nodes only.
    No preview · Article · May 2008 · Oncologie
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