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Hodgkin's disease: The salvage of radiation treatment failures

1977; Elsevier BV; Volume: 2; Issue: 9-10 Linguagem: Inglês

10.1016/0360-3016(77)90208-5

1879-355X

Vincent T. DeVita,

Hepatocellular Carcinoma Treatment and Prognosis

Hodgkin's disease, Radiation treatment failures-salvage of, Combined chemotherapy (MOPP).The therapy of all stages of Hodgkin's disease has improved dramatically in the past decade with the advent of more refined staging, radiotherapy, and combination chemotherapy.However, although the situation is far better than a mere decade ago, all is not well; the therapy works, it cures, but it is morbid and needs improvement.A significant fraction of patients treated primarily with either radiotherapy for Stages I and II disease or combination chemotherapy for Stages III and IV still relapse (about 30% of the former and 45% of the: latter): more investigators are appropriately turning their attention to the proper approach to salvage of the relapsing patient.The available data, in toto, suggests that those patients who relapse do not fare as well with retreatment with the same mode of therapy as patients with an equivalent volume (stage) of tumor treated per primum.While the reasons for this less dramatic response to second treatment with the same type of therapy are not entirely clear, it is easy to speculate that more widespread relatively silent dissemination of residual tumor is possible before redetection occurs.This is particularly true in areas that are difficult to examine, as in retrograde transdiaphragmatic extension to the retroperitoneal lymph nodes in patients who presented initially with supradiaphragmatic Hodgkin's disease and were treated with only involved field or mantle field radiotherapy.Such is the case in the study' relported by Weller et al. from Stanford in this issue of the journal.*Only 34% of their 40 patients with transdiaphragmatic extension were continuously free of disease in their second remission, three years after retreatment.Of particular interest are 28 patients who were retreated with radiotherapy alone, as. the second treatment; only 7 (25%) were rendered continuously free of Hodgkin's disease.In Table 6 of the paper it appears that of the remaining 17 patients, not treated yet a third time with radiotherapy, 6 (:35%) treated with combination chemotherapy (MOPP) were alive and free of