Retrospective analysis of results of treatment of 91 oral cavity cancers from 1982 to 1992]

PURPOSE: To analyse retrospectively the results of different treatment regimens of carcinomas of the floor of the mouth and tongue. MATERIALS AND METHODS: Between 1982 and 1992, 61 patients with carcinoma of the floor of the mouth and 30 with tongue cancer (25 stage I, nine stage II, 28 stage III, 29 stage IV) were treated in the radiotherapy department of Poitiers. Nine patients with stage I tumours were treated with 70 Gy low-dose rate brachytherapy only, without nodal dissection. Stages II and III were treated with combined surgery with neck dissection; and radiotherapy of stage II with nodal metastasis and for all stage III cases. Stage IV cases were treated either surgically if possible, or with combined chemotherapy and radiation. RESULTS: The five-year overall survival rate was 87.3% for stage I, 68.5% for stage II, 45.3% for stage III, and 0% for stage IV patients. Most relapses appeared in the first two years after treatment. Eight patients (32%) with stage I cancer developed nodal relapses, isolated in five cases. Complications of radiotherapy were acceptable. Four cases of osteonecrosis were observed after radiotherapy. All of these appeared simultaneously with a local relapse. CONCLUSION: These results are comparable with reports in the literature. The remarkable observation of our study is the high incidence of nodal recurrences after local treatment of stage I tumours. Therefore, local treatment is insufficient for early-stage tumours. The question of neck dissection for the early stage is discussed.     

腹股沟隐睾精原细胞瘤和阴囊睾丸精原细胞瘤预后的比较

目的分析腹股沟隐睾精原细胞瘤的预后,提出治疗方法。方法我们回顾性分析了１９５８～１９９１年治疗的４３例患者。根据我院精原细胞瘤分期标准,Ⅰ期３３例,Ⅱ期８例,Ⅲ、Ⅳ期各１例。所有患者均经腹股沟隐睾肿瘤切除术,Ⅰ、Ⅱ期以放射治疗为主,Ⅲ及Ⅳ期各１例分别行放疗或化疗。结果全组总的５年、１０年生存率分别为９３．０％和９０．３％,相应无病生存率分别为８８．１％和８５．３％。Ⅰ期５年、１０年总生存率均为１００％,Ⅱ期为７５．０％和６０．０％。２例复发,经放疗治愈。结论本组研究结果表明,腹股沟隐睾精原细胞瘤预后较好,和阴囊睾丸精原细胞瘤相似。建议对Ⅰ期、Ⅱ期早行术后腹主动脉旁和同侧盆腔淋巴结照射。当有腹股沟淋巴结转移或原发肿瘤明显侵及腹股沟周围组织时,再行腹股沟照射。     

The adjuvant role of two cycles of MOPP and low-dose lung irradiation in stage IA through IIB Hodgkin's disease: preliminary results

Fifty-eight laparotomy-staged I and II patients with upper torso presentations of Hodgkin's disease and 8 patients with lymphangiogram-staged lower torso disease were treated with radiotherapy alone or with 2 cycles of MOPP and radiotherapy. Patients with upper torso disease with either no mediastinal or only small mediastinal disease without hilar involvement and with no "B" symptoms were treated with mantle radiotherapy alone. Patients with large mediastinal masses or hilar disease were treated with 2 cycles of MOPP followed by definitive mantle irradiation and low dose lung irradiation. Those for whom "B" symptoms were the only adverse prognostic feature received 2 cycles of MOPP and mantle radiotherapy. Patients with lower torso disease were treated with radiotherapy alone if the disease was limited to the pelvis. Those with more extensive disease received 2 cycles of MOPP prior to radiotherapy. The 4-year survival for all 66 patients was 97%. The corresponding disease-free and freedom from second relapse figures were 77% and 92%. Survival for the patients with unfavorable presentations who received 2 cycles of MOPP and radiotherapy was 100%. It was 92% for the group with favorable presentations who were treated with radiotherapy only.     

Follicular lymphoma: prognostic factors for response and survival

One hundred forty-eight patients with newly diagnosed follicular lymphoma were treated over a 12-year period. Twenty-two patients received radiotherapy for stage I and II disease, followed by adjuvant chemotherapy in 14 patients. One hundred thirteen were treated at presentation with short courses of chemotherapy, most often with single-agent chlorambucil for bulky stage II and stages III and IV disease. Thirteen patients were managed expectantly until there was evidence of disease progression. The median survival was 9 years. Patients treated with radiotherapy for stage I and II disease had an 83% relapse-free survival, but those with bulky stage II or stages III and IV disease treated with chemotherapy pursued a remitting and relapsing course with a 70% response rate at initial and subsequent retreatments, but a median duration of remission of 4 years in stage III and 1 year in stage IV disease (P = .041). Patients were observed in relapse and retreatment was administered as appropriate, once every 33 months on average. Poor prognosis patients could be identified by a combination of the presentation characteristics: B symptoms, hepatosplenomegaly, anemia, and abnormal liver function. These factors predicted a poor response to treatment and correlated with a short survival. Histologic subgroups were not associated with differences in survival, but transformation to a diffuse high-grade lymphoma was observed in 23 of the 72 patients (32%) at risk, with a median follow-up of 6 years and 6 months, and was associated with a very poor prognosis. The present treatment strategy has proved successful for most patients with localized disease and those older patients with indolent small volume disseminated follicular lymphoma. New approaches are being investigated for the younger poor prognosis patients.     

Postoperative radiation of retinoblastoma--report on 22 patients

From July 1958 to December 1979, 22 patients with retinoblastoma were treated postoperatively by radiotherapy. All were proved by pathology. There were 12 stage I, 1 stage II, 8 stage III and 1 stage IV lesions. Radiation dose was more than 15 Gy and most of the patients received 40-50 Gy in 4-5 weeks. The overall cancer free 5 year survival rate was 55% (12/22). The 5 year survival rate of stage I patients was 75% (9/12), and that of stage III patients was 38% (3/8). None of the stage II and IV patients survived. Dose of 40-50 Gy/4-5 wk is considered to be optimal for control of the tumor. Dose higher than 60 Gy/6 wk could lead to retarded growth in the orbital and temporal bony structures if the patient survives for ten years or more.     

Ten-year nodular sclerosis Hodgkin's disease and second malignancies

Hodgkin's disease is one of the most curable cancers thanks to progress in radiotherapy and multi-drug chemotherapy regimens such as mechloretamine-vincristine-procarbazine-prednisone, best known as MOPP. However, long-term side-effects and treatment-induced second malignancies are of great concern. In our institution, 69 patients with nodular sclerosis Hodgkin's disease were treated over 10 years. Twenty-two per cent were stage I, 49% stage II, 23% stage III and 6% stage IV. Actuarial 10-year survival was 83% and actuarial relapse-free survival 61%. Six patients developed a second malignancy with a 10-year actuarial risk of 18%. All six cases occurred in the group treated with MOPP and extensive radiotherapy. Acute non-lymphoblastic leukemia occurred in three patients, preleukemia in two and non Hodgkin's lymphoma in one. In all of these patients, the results were quite poor. Overall survival was equally affected by Hodgkin's disease and by second malignancies. Since new multiple-drug chemotherapy regimens such as adriamycin-bleomycin-vinblastine-dacarbazine, known as ABVD, are equally effective and seem less likely to induce second hematologic malignancies, we suggest that MOPP should no longer be used as a first choice for the treatment of Hodgkin's disease, especially when in combination with radiation therapy.     

晚期霍奇金病128例临床总结分析

目的 探讨晚期霍奇金病的合理治疗方法。方法 对１２８例晚期霍奇金病的治疗结果进行了总结和分析。结果 总有效率９６．１％（１１２／１２７）,其中完全缓解（ＣＲ）率８．５％,化放疗组、单化疗组和单放疗组的ＣＲ率分别为６９．７％、５８．３％和１００％。全组１,３,５,１０年生存率分别为．４％、７０．３％、５６．８％和５２．４％。生存率分析显示,临床Ⅲ期,无全身症状、无巨块型、淋巴细胞为主型和结节经型、化     

The review of the treatment of the carcinoma of the uterine cervix in Gifu University Hospital. Primary treated cases from 1972 to 1982

Clinical study was performed to review the treatment of carcinoma of the uterine cervix in 525 cases treated by surgery, radiotherapy, the combination of both, and others at Dept. of Obstetrics and Gynecology, Gifu University Hospital during 10 years from April 1, 1972 through March 31, 1982. 1) Of 525 cases, 80 were classified as stage 0 by the criteria of FIGO, 178 as stage I (39 as Ia, 139 as Ib), 164 as stage II(8 as IIa, 156 as IIb), 98 as stage III and 5 as stage IV. 2) The five year cumulative survival rate was 78.2% for all invasive 445 cases excluding stage 0, 93.8% for stage I, 82.3% for stage II, 45.9% for stage III, and 20.0% for stage IV. 3) The five year cumulative survival rate was 85.1% for stage II cases which were treated by surgery or the combination of surgery and radiotherapy, and 63.8% for stage III. However the five year cumulative survival rate was 60.0% for stage II cases which were treated by radiotherapy only, and 32.0% for stage III. 4) The rate for the cases with adenocarcinoma was 3.8% (17/445) in all invasive carcinoma of the uterine cervix. The five year cumulative rate was 47.1% for the cases with adenocarcinoma, and 79.4% for those with squamous cell carcinoma.     

Postoperative radiotherapy of squamous cell carcinoma of the tonsil. Factors influencing survival and time to recurrence.

From 1970 to 1988, 40 patients with squamous cell carcinoma of the tonsillar region were treated with surgery and postoperative split-course radiotherapy. The 5-year survival rate for all the patients was 52.5%; the corresponding figure was 100% in stage I, 75% in stage II, 63% in stage III and 15% in stage IV. The local control rate was 100% in stage I, 89% in stage II, 87% in stage III and 38% in stage IV. In the proportional hazards regression analysis T- and N-category and pretreatment Karnofsky index had the strongest association to survival, whereas T- and N-category and total radiation dose were most strongly associated to time to recurrence.     

ABVD and radiation therapy as first-line treatment in advanced Hodgkin's disease

The purpose of this study was to evaluate the efficacy of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and radiotherapy in advanced Hodgkin's disease. In addition, to evaluate whether patients with slow responding tumors could profit from the early change of treatment regimen [MOPP (mechloretamine, vincristine, procarbazine, and prednisone)] followed by radiation therapy or autologous bone marrow transplantation (ABMT). Finally, to evaluate treatment options for patients with both early and late relapses. A total of 78 patients with previously untreated stages IIA bulky, IIB, III (A and B), and IV (A and B) Hodgkin's disease were treated with the ABVD regimen followed by radiotherapy. Patients with stages IIIB and IV (A and B) were re-staged after 4 ABVD courses of the treatment: slow responders (response less than 70%) underwent second-line treatment (MOPP) and eventually ABMT. Relapsed patients with a long initial complete response (> or = 12 months) were treated with second-line conventional treatment and those patients with a short initial complete response (< 12 months) underwent ABMT. The complete response (CR) rate was 91% after ABVD and radiation therapy. An additional 5 stage IIIB and IV patients whose therapy was switched after 4 cycles because of a slow response obtained a CR (3 after 2 MOPP courses plus radiotherapy and 2 after 2 MOPP courses followed by ABMT). Including these additional CRs, the overall CR rate was 97%. No episodes of clinical cardiopulmonary toxicity were observed. With a median follow-up time of 42 months, the 4-year relapse-free survival was 87%. The 4-year overall survival was 96%. Ten cases relapsed: all but one obtained a second CR with different approaches depending on the timing of relapse. The ABVD regimen appears to be effective and well tolerated confirming the validity of this four-drug regimen in the treatment of advanced Hodgkin's disease. In addition, therapeutic choices based on the timing of the relapse and the use of re-staging after 4 cycles in order to identify slow responders can play an important role in increasing the number of cured patients.     

Retrospective analysis of results of treatment for nasopharyngeal carcinoma in Macao

Background： Nasopharyngeal carcinoma （NPC） is a common malignancy in Southeast Asia, however, a full consensus has not yet been reached as to the value of comprehensive treatment for NPC. This study was designed to evaluate the epidemiological characteristics of NPC and their prognostic value, as well as the long-term efficacy of NPC treatment. Patients and methods： A total of 248 patients, with different stages of NPC, were included in this study. Results： The 5-year overall survival （OS） rates for patients in stages I, II, lII and IV were 90.48%, 76.71%, 76.89% and 33.87%, respectively （P=0.000）, while the respective 5-year progression-free survival （PFS） rates were 85.15%, 72.36%, 63.88% and 26.26% （P=0.000）. The respective 5-year OS rates, according to stage, for the group that received radiotherapy combined with chemotherapy and for the group that received radiotherapy only were as follows： stages I and II, 81.67% and 79.59% （P=0.753）; stage III, 79.91% and 70.38% （P=0.143）; stage IV,, 35.22% and 0% （P=0.000）. The respective 5-year PFS rates in these groups were as follows： stages I and II, 75.83% and 74.98% （P=0.814）; stage III, 74.08% and 42.25% （P=0.027）; stage IV,, 27.31% and 0% （P=0.000）. Conclusions： Clinical staging appears to be the most important prognostic factor for NPC. As the stage number increases, both the 5-year OS and PFS significantly decrease. Adding chemotherapy to radiotherapy was not advantageous for patients with stage I or II NPC, however the addition of chemotherapy to radiotherapy significantly improved OS and PFS in patients with stage IV NPC. The addition of chemotherapy improved PFS, but not OS in patients with stage III NPC.     

Treatment of pediatric Hodgkin's disease with chemotherapy alone or combined modality therapy

Optimal treatment for Hodgkin's disease during childhood is unknown. We report the treatment outcome of patients with Hodgkin's disease <13 years of age seen at the American University of Beirut Medical Center (AUBMC) between 1980 and 1996. A retrospective review of the medical records of 24 children treated for HD at AUBMC was performed. Treatment consisted of chemotherapy alone (n = 15) or chemotherapy plus involved field radiotherapy (n = 9). Chemotherapy consisted of COPP, ABVD, or alternating cycles of each for a total of 6 to 12 cycles, depending on clinical and radiological response; three patients received MOPP. Five patients in the chemotherapy group had clinical stage (CS) I and II and 10 had CS III disease. In the combined modality group, eight patients had CS I and II and one had CS IV disease. At a median follow-up of 5 years, the event-free survival (EFS) for the combined modality group was 100% and the overall survival (OS) 100%. For the chemotherapy alone group, the EFS was 56% and the OS was 79%. Four patients (27%) in the chemotherapy alone group who had Stage IIIB disease relapsed. Mean time to relapse was 4.3 years. In our experience, six cycles of COPP or (COPP plus ABVD) alone were suboptimal for the treatment of Stage IIIB Hodgkin's disease patients, especially those with involvement of lower abdominal nodes (III2B), extensive pulmonary disease, or mixed cellularity histology. Radiation therapy or additional chemotherapy courses are required for these patients.     

Primary lymphoma of bone--a retrospective study. Experience at the Northern Israel Oncology Center (1979-2000)

OBJECTIVE: This retrospective study describes our experience with the diagnosis, treatment, results and long-term follow-up of primary bone lymphoma (PBL). PATIENTS AND METHODS: Nineteen patients diagnosed with PBL were reviewed. Seven patients presented with stage I(E) disease, four with stage II(E) (regional lymphadenopathy), and eight with stage IV disease (disseminated bone involvement). Only one stage IV patient exhibited 'B' symptoms. The majority (72%) demonstrated diffuse, large cell, B-type lymphoma. All patients were treated with adriamycin-based chemotherapy and consolidation radiotherapy to the primary site (8 patients: early PBL) or the most bulky area (3 patients: stage IV PBL). RESULTS: Ten stage I(E)/II(E) patients are alive with no evidence of disease (NED) and only one died due to metastatic secondary lung cancer while with NED from his PBL. Eight stage IV patients are alive with NED. Median follow-up for all living patients: 77 months. Side effects were mild and did not necessitate delay in treatment. CONCLUSIONS: Our departmental policy of treating PBL patients with an anthracycline-based regimen and involved field radiotherapy proved to be successful in achieving excellent long-term, disease-free survival. Phase III randomized, controlled, clinical trials will determine the true role of consolidation radiotherapy in PBL, when considering severe late side effects, including radiation-induced bone tumors.     

Two cycles of MOPP and radiotherapy for stage III1A and stage III1B Hodgkin's disease

One hundred two adult patients with stage III1A (76 patients) and stage III1B (26 patients) Hodgkin's disease were treated with two cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and radiotherapy (XRT) between 1970 and 1984. Sixty-four of the patients were treated between 1970 and 1978 with two cycles of MOPP and XRT to the mantle, upper abdomen, and pelvis. The remaining 38 patients were treated from 1978 to 1984 with a modification of the protocol in which pelvic XRT was omitted and low-dose whole-lung XRT was administered to patients with unfavorable mediastinal disease. The 10-year actuarial freedom-from-progression (FFP) and determinate survival rates at a mean follow-up of 93 months were 84% and 86% for stage III1 disease, 86% and 84% for stage III1A disease, and 78% and 91% for stage III1B disease. Three patients died of treatment-related toxicities without evidence of Hodgkin's disease, two died of complications of myelosuppression and one of acute nonlymphocytic leukemia (ANLL). Neither FFP nor determinate survival rates were significantly influenced by B symptoms, unfavorable mediastinal disease, histologic subtype, extent of abdominal disease, the omission of pelvic XRT, the use of whole-lung XRT, or the number of splenic nodules. Patients 40 years of age or older had a 73% determinate survival rate at 10 years compared with 88% for patients younger than 40 years (P = .01). This survival difference was due to treatment-related toxicity in the older group. This study indicates that two cycles of MOPP and XRT to the mantle and upper abdomen is as effective as more intensive treatment for all patients with stage III1 Hodgkin's disease. This treatment program can preserve fertility and has had only a 1% actuarial incidence of ANLL at 15 years.     

鼻咽非霍奇金淋巴瘤的临床与预后分析

目的 探讨鼻咽非霍奇金淋巴瘤的临床特点、治疗及国际预后指数(IPI)的应用价值。方法 回顾性分析1983—1997年间136例首程治疗的鼻咽非霍奇金淋巴瘤患者的临床资料。按照工作分类原则进行分类,高度恶性18例,中度恶性77例,低度恶性2例,未分类39例。根据Ann Arbor分期,Ⅰ期25例,Ⅱ期91例,Ⅲ期12例,Ⅳ期8例。Ⅰ期单纯放疗13例,综合治疗12例;Ⅱ期单纯放疗31例,综合治疗57例,Ⅲ和Ⅳ期以化疗为主。结果 5年和10年总生存率(OS)、癌症相关生存率(CSS)和无病生存率(OFS)分别为56．2％和48．3％,61．2％和58．0％,51．1％和46．5％。IPI为0,1及2～3分的5年CSS分别为70．9％、44．9％、30．0％(P=0．004)。Ⅰ期化放疗综合治疗和单纯放射治疗的5年CSS分别为82．2％和83．1％,10年CSS分别为82．2％和66．4％,差异无显著性(P=0．779)。Ⅱ期综合治疗和单纯放射治疗5年CSS分别为70．9％和46．0％,10年CSS分别为65．4％和46．0％,差异有显著性(P=0．04)。Cox多因素分析显示,影响预后的因素为Ann Arbor分期、B组症状和IPI。结论 IPI是判断原发于鼻咽非霍奇金淋巴瘤预后的重要指标,Ⅱ期鼻咽非霍奇金淋巴瘤应考虑综合治疗。     

Report on 114 primary vaginal carcinomas

114 patients with primary carcinoma of the vagina were treated in our hospital from 1958 to 1978. It accounted for 0.83% of all gynecological malignant tumors in the same period. The youngest was 26 years of age, the oldest 75. Patients 40-59 years comprised 61.4%. 33% of patients had wedding age under 17. 63.4% had more than 4 pregnancies and 58.4% gave more than 4 births. 89.69% was diagnosed as squamous cell carcinoma, 7.2% as adenocarcinoma, 2.06% as undifferentiated carcinoma and 1 as embryonic carcinoma. The tumor occurred frequently in the upper third and posterior wall of the vagina (60% and 68%). In this series, there were 21 stage I, 29 stage II, 61 stage III and 3 stage IV lesions. 110 patients were treated by radiotherapy in different schemes. Intracavitary radium or caesium plus 60Co external irradiation by four fields gave better result with a 5 year survival rate of 66.1%. Only 2 out of 12 patients were cured by 60Co rotation alone but if supplemented by intracavitary radium or caesium, the cure rate was increased. The 5 year survival rate was 71.4% for stage I, 62.1% for stage II, 42.6% for stage III and O for stage IV. After the radiotherapy, rectovaginal fistula developed in 1 patient, vesicovaginal fistula in 1. 14% was complicated with rectal bleeding and 8.18% with hematuria.     

Chemotherapy for early-stage gastrointestinal lymphoma

Summary A total of 176 patients with gastrointestinal lymphomas were reviewed. According to a modified staging classification, 51 of them had stage I/II disease and the remaining 125 had stage III/IV disease. In most cases (68%), the histology was intermediate-grade according to the NIH working formulation, and the B-cell immunophenotype was involved in 89% of the 45 cases with a known immunophenotype. The primary site was the stomach in 56% of cases and the bowel in 44%. A significantly higher proportion (P=0.001) of those with bowel lymphomas had stage III/IV disease (88% vs 57%). The primary gastrointestinal lesion was resected in 122 patients, including all 51 cases of stage I/II disease. In all, 8 stage I/II patients were given radiotherapy alone following surgery and the other 43 underwent chemotherapy; of the latter, 19 received additional radiotherapy following chemotherapy. Chemotherapy was also given to 112 stage III/IV patients, 42 of whom underwent additional radiotherapy. Factors associated with a poorer prognosis included advanced disease, bowel lymphoma and advanced age. Although the complete response (CR) rate according to disease stage was similar, stage I/II patients receiving chemotherapy showed a significantly lower relapse rate, better disease-free survival following CR and improved survival as compared with those receiving radiotherapy alone. However, additional radiotherapy following chemotherapy did not further improve the clinical outcome.Supported by a grant from the Haematology Research Fund, Department of Medicine, University of Hong Kong     

High relapse rate in children with non-advanced nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL or nodular paragranuloma) treated with chemotherapy only

Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) is a rare variant of Hodgkin's lymphoma (HL) in children. Since specific immunohistochemical staining has become available, NLPHL can be separated from classical Hodgkin's lymphoma (cHL) more accurately. Scarce information is available about pediatric NLPHL treated with chemotherapy only. Therefore, clinical characteristics, treatment, response and outcome of seven pediatric NLPHL patients, median age 9.2 years (range 7.5 - 14.2 years), diagnosed between 1986 - 2003 among 58 HL patients, uniformly treated in a single center with chemotherapy only, were evaluated. The median follow-up time was 4.2 years (range 2.1 - 10.2 years). NLPHL patients were stage I (n = 5), II (n = 2), whereas cHL, median age 11.4 years (range 3.3 - 15.9 years), were stage I (n = 8), II (n = 17), III (n = 9), IV (n = 1). Upfront treatment of NLPHL patients consisted of six courses of epirubicin, bleomycin, vinblastine and dacarbazine (EBVD) without radiotherapy, whereas cHL patients received six courses of EBVD (n = 14) or 4 - 6 courses of EBVD/MOPP (mitoxin, oncovin, procarbazine, prednison; n = 21). Chemotherapy was used as primary treatment thereby aiming to avoid radiotherapy with potential serious side effects to growing jaws and thyroid. All seven patients reached complete remission (CR). Four patients relapsed, of which three locally. These three were salvaged with second-line chemotherapy without radiation therapy (RT) and are in second CR. One patient relapsing with stage III disease was salvaged by EBVD/MOPP followed by autologous BMT and is also in second CR for 36 months. The event-free survival (EFS) is 43% and overall survival (OS) 100%. This study shows that apart from histology, immunohistochemistry (ICH) is required for diagnosing NLPHL. Moreover, it illustrates that although cure of pediatric NLPHL is feasible with chemotherapy only, high dosages of cytotoxic drugs are necessary as salvage treatment in a relatively high proportion of patients after relapse.     

Hodgkin's disease in children. Results of therapy in a mixed group of 178 clinical and pathologically staged patients over 13 years

One hundred seventy-eight previously untreated children with biopsy-proven Hodgkin's disease of clinical Stages I and II were treated and followed between 1965 and 1978. Staging laparotomy was performed in 30 patients. Ninety-four percent of the patients obtained a complete remission; 24 patients have died. The actuarial survival rate for all patients was 90% at 5 years, and 81% at 10 years. The disease-free survival rate was 69% at 5 years, and 65% at 10 years. When nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP) chemotherapy was added to either extended field or involved field irradiation, the relapse rate was significantly decreased as compared with the protocols without MOPP and prophylactic para-aortic irradiation. The authors believe that surgical staging may not be necessary as splenic involvement may be treated in some patients by MOPP chemotherapy alone or in association with splenic paraaortic radiotherapy. However, the side effects of MOPP need further study by other chemotherapy programs.     

Survival improvement of young patients, aged 16-23, with Hodgkin lymphoma (HL) during the last three decades

The prognostic factors, treatments and outcomes of 55 young adults (16-23 years old) with Hodgkin lymphoma (HL) treated in the Second Department of Internal Medicine Propaedeutic, Medical Oncology Unit, Athens University, over the past 25 years, are reviewed. Patients were treated with the chemotherapy regimens available at each time period which were MOPP (Group A; 1978-1987), MOPP/ABVD (Group B; 1988-1993) and BEACOPP or ABVD (Group C; 1994-2003). The eligible patients, received radiotherapy (RT) according to treatment consensus. Additionally, the patients were retrospectively divided according to risk factors (abnormal erythrocyte sedimentation rate (ESR), bulky mediastinal disease, > 3 involved nodes and extranodal involvement) into low [stage I/II; five patients (9%)], intermediate [stage III with adverse prognostic factors; 18 patients (33%)] and high risk categories [stages IIB bulky and III/IV; 32 patients (58%)]. A total of 21 (38%) patients experienced relapse (three intermediate and 19 high risk). The 5-year survival and the 5-year event free survival (EFS) figures were Group A: 65% and 53%, Group B: 80% and 65%, Group C: 100% and 88.5%, respectively, the improvements between Group B and C were statistically significant (p = 0.04 and p = 0.005, respectively) among the three time periods. The overall survival (OS) and EFS differed significantly between intermediate and high risk categories (OS: p = 0.04, EFS: p = 0.005). The sequential use of RT did not influence OS and EFS but there was a trend of improvement with RT in the later periods. Survival of young patients with HL is significantly improving most probably due to improved chemotherapy treatment and understanding of the risk factors. Current controversial issues surrounding this disease, including the role of radiotherapy, positron emission tomography (PET), bone marrow biopsy and stem cell transplantation are discussed.