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Long-term events in adult patients with clinical stage IA-IIA nonbulky Hodgkin's lymphoma treated with four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and adjuvant radiotherapy: a single-institution 15-year follow-up.
Clin Cancer Res 2006; 12(21):6487-93CC

Abstract

PURPOSE

To report on long-term events after short doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy and adjuvant radiotherapy in favorable early-stage Hodgkin's lymphoma.

EXPERIMENTAL DESIGN

We monitored late events and causes of death over 15 years (median follow-up, 120 months) in 120 patients with nonbulky stage IA-IIA Hodgkin's lymphoma, treated with four cycles of ABVD and limited radiotherapy. Pulmonary and cardiac function tests were done throughout the follow-up. Outcome measures included cause-specific mortality, standardized mortality ratio, and standardized incidence ratio for secondary neoplasia.

RESULTS

Projected 15-year event-free and overall survival were 78% and 86%, and tumor mortality was 3%. Standardized mortality ratio was significantly higher than 1 for both males (2.8; P=0.029) and females (9.4; P=0.003). The risk of cardiovascular events at 5 and 12 years was 5.5% and 14%, with a median latent time of 67 months (range: 23-179 months) from the end of radiotherapy. Pulmonary toxicity developed in 8% of patients; all had received mediastinal irradiation and the median time from radiotherapy to pulmonary sequelae was 76 weeks (range: 50-123 weeks). The risk of secondary neoplasia at 5 and 12 years was 4% and 8%, respectively, with no cases of leukemia. Fertility was preserved.

CONCLUSIONS

Long-term events were mostly related to radiotherapy; the role of short ABVD chemotherapy was very limited, as documented by fertility preservation and lack of secondary myelodysplasia/leukemia. A proportion of patients died from causes unrelated to disease progression and the excess mortality risk was mostly due to the occurrence of secondary neoplasms and cardiovascular diseases. A moderate dose reduction of radiotherapy from 40-44 Gy to 30-36 Gy did not decrease the risk of late complications; abolishing radiotherapy in nonbulky early-stage Hodgkin's lymphoma is being evaluated.

Authors+Show Affiliations

Clinica Ematologica and Servizio di Radioterapia Oncologica, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, University of Pavia, Pavia, Italy. ebrusa@smatteo.pv.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17085663

Citation

Brusamolino, Ercole, et al. "Long-term Events in Adult Patients With Clinical Stage IA-IIA Nonbulky Hodgkin's Lymphoma Treated With Four Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine and Adjuvant Radiotherapy: a Single-institution 15-year Follow-up." Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, vol. 12, no. 21, 2006, pp. 6487-93.
Brusamolino E, Baio A, Orlandi E, et al. Long-term events in adult patients with clinical stage IA-IIA nonbulky Hodgkin's lymphoma treated with four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and adjuvant radiotherapy: a single-institution 15-year follow-up. Clin Cancer Res. 2006;12(21):6487-93.
Brusamolino, E., Baio, A., Orlandi, E., Arcaini, L., Passamonti, F., Griva, V., ... Lazzarino, M. (2006). Long-term events in adult patients with clinical stage IA-IIA nonbulky Hodgkin's lymphoma treated with four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and adjuvant radiotherapy: a single-institution 15-year follow-up. Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, 12(21), pp. 6487-93.
Brusamolino E, et al. Long-term Events in Adult Patients With Clinical Stage IA-IIA Nonbulky Hodgkin's Lymphoma Treated With Four Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine and Adjuvant Radiotherapy: a Single-institution 15-year Follow-up. Clin Cancer Res. 2006 Nov 1;12(21):6487-93. PubMed PMID: 17085663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term events in adult patients with clinical stage IA-IIA nonbulky Hodgkin's lymphoma treated with four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and adjuvant radiotherapy: a single-institution 15-year follow-up. AU - Brusamolino,Ercole, AU - Baio,Ambrogia, AU - Orlandi,Ester, AU - Arcaini,Luca, AU - Passamonti,Francesco, AU - Griva,Vassiliki, AU - Casagrande,William, AU - Pascutto,Cristiana, AU - Franchini,Pietro, AU - Lazzarino,Mario, PY - 2006/11/7/pubmed PY - 2007/1/11/medline PY - 2006/11/7/entrez SP - 6487 EP - 93 JF - Clinical cancer research : an official journal of the American Association for Cancer Research JO - Clin. Cancer Res. VL - 12 IS - 21 N2 - PURPOSE: To report on long-term events after short doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy and adjuvant radiotherapy in favorable early-stage Hodgkin's lymphoma. EXPERIMENTAL DESIGN: We monitored late events and causes of death over 15 years (median follow-up, 120 months) in 120 patients with nonbulky stage IA-IIA Hodgkin's lymphoma, treated with four cycles of ABVD and limited radiotherapy. Pulmonary and cardiac function tests were done throughout the follow-up. Outcome measures included cause-specific mortality, standardized mortality ratio, and standardized incidence ratio for secondary neoplasia. RESULTS: Projected 15-year event-free and overall survival were 78% and 86%, and tumor mortality was 3%. Standardized mortality ratio was significantly higher than 1 for both males (2.8; P=0.029) and females (9.4; P=0.003). The risk of cardiovascular events at 5 and 12 years was 5.5% and 14%, with a median latent time of 67 months (range: 23-179 months) from the end of radiotherapy. Pulmonary toxicity developed in 8% of patients; all had received mediastinal irradiation and the median time from radiotherapy to pulmonary sequelae was 76 weeks (range: 50-123 weeks). The risk of secondary neoplasia at 5 and 12 years was 4% and 8%, respectively, with no cases of leukemia. Fertility was preserved. CONCLUSIONS: Long-term events were mostly related to radiotherapy; the role of short ABVD chemotherapy was very limited, as documented by fertility preservation and lack of secondary myelodysplasia/leukemia. A proportion of patients died from causes unrelated to disease progression and the excess mortality risk was mostly due to the occurrence of secondary neoplasms and cardiovascular diseases. A moderate dose reduction of radiotherapy from 40-44 Gy to 30-36 Gy did not decrease the risk of late complications; abolishing radiotherapy in nonbulky early-stage Hodgkin's lymphoma is being evaluated. SN - 1078-0432 UR - https://www.unboundmedicine.com/medline/citation/17085663/Long_term_events_in_adult_patients_with_clinical_stage_IA_IIA_nonbulky_Hodgkin's_lymphoma_treated_with_four_cycles_of_doxorubicin_bleomycin_vinblastine_and_dacarbazine_and_adjuvant_radiotherapy:_a_single_institution_15_year_follow_up_ L2 - http://clincancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=17085663 DB - PRIME DP - Unbound Medicine ER -