Abstract
During last decades, there are strengthening attitudes to optimize the treatment of Hodgkin's lymphoma considering prognostic groups and risk factors. Based on the data of Vilnius University Clinics, a retrospective study was carried out, and treatment methods and outcomes of the patients treated during 1999-2004 were analyzed. Medical histories of 114 patients younger than 60 years were reviewed. Median age was 28 years. In 83% of cases, classic nodular sclerotic Hodgkin's lymphoma was diagnosed. Advanced-, intermediate-, and early-stage disease was diagnosed in 55%, 38%, and 7% of cases, respectively. The patients with early-stage disease underwent four ABVD chemotherapy courses; 88% of them underwent radiotherapy afterwards. The patients with intermediate-stage disease underwent 4-6 courses of ABVD or in minor cases (12% of patients with intermediate-stage disease) - 4 standard BEACOPP chemotherapy courses. After this treatment, 88% of patients with intermediate-stage disease underwent radiotherapy. Patients with advanced-stage disease underwent 8 escalate (44%) or standard BEACOPP (29%) chemotherapy courses. More than half of these patients (71%) underwent radiotherapy after chemotherapy. Patient follow-up median was 65 months. One hundred seven patients (94%) after primary treatment achieved complete remission, in 7 patients (6%) primary progression was observed, 12 patients (11%) relapsed, and 8 patients died. Overall survival and event-free survival in patients with early-stage disease was 100%. Overall survival in patients with early/intermediate- and advanced-stage disease was 95.1% and 84.0%, respectively. Event-free survival in patients with early/intermediate- and advanced-stage disease was 91.7% and 76.2%, respectively. In the groups of intermediate- and advanced-stage disease, the results of treatment were worse in the subgroup, which underwent extended-field radiotherapy (P<0.05). Overall survival in the group of patients with advanced-stage disease was the best who underwent ABVD scheme, but the event-free survival (70.6%) and disease-free survival (81.3%) in ABVD subgroup were worse compared to BEACOPP subgroup. According to our results, there was no statistically significant difference in survival of patients with advanced-stage disease who underwent or did not radiotherapy (P>0.05).
Highlights
The patients with early-stage disease underwent four ABVD chemotherapy courses; 88% of them underwent radiotherapy afterwards
Overall survival in the group of patients with advanced-stage disease was the best who underwent ABVD scheme, but the event-free survival (70.6%) and disease-free survival (81.3%) in ABVD subgroup were worse compared to BEACOPP subgroup
Straipsnis gautas 2008 11 10, priimtas 2009 08 04 Received 10 November 2008, accepted 4 August 2009
Summary
Raktažodžiai: Hodžkino limfoma, kombinuotas gydymas, chemoterapija, radioterapija. Santrauka. Išgyvenamumas be neigiamų įvykių nedidelės, vidutinės ir didelės rizikos grupės ligoniams buvo atitinkamai – 91,7 ir [76,2] proc. Gydytų pagal ABVD schemą, bendrasis penkerių metų išgyvenamumas buvo geriausias, tačiau išgyvenamumas be neigiamų įvykių (70,6 proc.) ir be ligos atkryčio išgyvenamumas (81,3 proc.) taikant ABVD chemoterapiją buvo blogesni negu taikant BEACOPP chemoterapijos schemą. Mūsų tyrimo tikslas – pirmą kartą Lietuvoje įvertinti ir pristatyti sergančiųjų ankstyvosios stadijos HL, vidutinės ir didelės rizikos grupės ligonių, gydytų 1999–2004 m., gydymo rezultatus taikant šiuolaikines chemoterapijos schemas su skirtingų dydžių radioterapija. Gydymas buvo skiriamas įvertinus ligonių prognostinę kategoriją: nedidelės rizikos grupės ligoniams buvo skiriami keturi ABVD kursai ir radioterapija; vidutinės rizikos grupės ligoniams – šeši ABVD kursai arba keturi baziniai BEACOPP kursai ir radioterapija; didelės stadijos ligoniams (pagal paciento pasirinkimą) – aštuoni bazinio arba eskaluoto BEACOPP arba aštuoni ABVD kursai, radioterapija taikyta tik į liktinę ligą arba į ligos pradžioje diagnozuotą masyvų tarpuplautį.
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