%0 Journal Article %1 Loeffler.1997b %A Loeffler, Markus %A Diehl, Volker %A Pfreundschuh, Michael %A Rühl, U. %A Hasenclever, Dirk %A Nisters-Backes, H. %A Sieber, M. %A Tesch, H. %A Franklin, J. %A Geilen, W. %A Bartels, H. %A Cartoni, C. %A Dölken, G. %A Enzian, J. %A Fuchs, R. %A Gassmann, W. %A Gerhartz, H. %A Hagen-Aukamp, U. %A Hiller, E. %A Hinkelbein, H. %A Hinterberger, W. %A Kirchner, H. %A Koch, P. %A Krüger, B. %A Schwarze, E. W. %D 1997 %J Journal of clinical oncology : official journal of the American Society of Clinical Oncology %K IMISE-Publikationen %N 6 %P 2275–2287 %T Dose-response relationship of complementary radiotherapy following four cycles of combination chemotherapy in intermediate-stage Hodgkin's disease %V 15 %X PURPOSE To determine the appropriate irradiation dose after four cycles of modern combination chemotherapy in nonbulky involved field (IF/BF) and noninvolved extended-field (EF/IF) sites in patients with intermediate-stage Hodgkin's disease (HD). MATERIALS AND METHODS HD patients in stage I to IIIA with a large mediastinal mass, E stage, or massive spleen involvement were treated with two double cycles of alternating cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) plus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by EF irradiation in two successive trials (HD1 and HD5). In the HD1 trial (1983 to 1988), 146 patients who responded to chemotherapy were randomized to receive 20 Gy (70 patients) or 40 Gy (76 patients) of EF irradiation in all fields outside bulky disease sites. A cohort of 111 patients who fulfilled the same inclusion criteria in the subsequent trial HD5 (1988 to 1993) were treated with 30 Gy. Bulky disease always received 40 Gy. RESULTS Freedom-from-treatment-failure (FFTF) and survival (SV) curves showed no differences between the 20-, 30-, and 40-Gy groups. However, acute toxicities were more frequent in the 40-Gy arm. Analysis of relapse patterns showed that 18 of 26 relapsing patients either failed to respond in initial bulky sites (n = 5) or had an extranodal relapse (n = 9) or both (n = 4). After 5 years, the cumulative risk for relapse in bulky sites is 10\%, despite 40 Gy of radiation. CONCLUSION Our results strongly suggest that there is no relevant radiotherapy dose effect in the range between 20 Gy and 40 Gy in IF/BF and EF/IF after 4 months of modern polychemotherapy in patients with intermediate-stage HD. Relapse patterns indicate that patients destined to relapse need more systemic, rather than local, treatment. Based on our data, we conclude that 20 Gy is sufficient in EF/IF of intermediate-stage HD following four cycles of modern polychemotherapy.

@article{Loeffler.1997b, abstract = {PURPOSE To determine the appropriate irradiation dose after four cycles of modern combination chemotherapy in nonbulky involved field (IF/BF) and noninvolved extended-field (EF/IF) sites in patients with intermediate-stage Hodgkin's disease (HD). MATERIALS AND METHODS HD patients in stage I to IIIA with a large mediastinal mass, E stage, or massive spleen involvement were treated with two double cycles of alternating cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) plus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by EF irradiation in two successive trials (HD1 and HD5). In the HD1 trial (1983 to 1988), 146 patients who responded to chemotherapy were randomized to receive 20 Gy (70 patients) or 40 Gy (76 patients) of EF irradiation in all fields outside bulky disease sites. A cohort of 111 patients who fulfilled the same inclusion criteria in the subsequent trial HD5 (1988 to 1993) were treated with 30 Gy. Bulky disease always received 40 Gy. RESULTS Freedom-from-treatment-failure (FFTF) and survival (SV) curves showed no differences between the 20-, 30-, and 40-Gy groups. However, acute toxicities were more frequent in the 40-Gy arm. Analysis of relapse patterns showed that 18 of 26 relapsing patients either failed to respond in initial bulky sites (n = 5) or had an extranodal relapse (n = 9) or both (n = 4). After 5 years, the cumulative risk for relapse in bulky sites is 10\%, despite 40 Gy of radiation. CONCLUSION Our results strongly suggest that there is no relevant radiotherapy dose effect in the range between 20 Gy and 40 Gy in IF/BF and EF/IF after 4 months of modern polychemotherapy in patients with intermediate-stage HD. Relapse patterns indicate that patients destined to relapse need more systemic, rather than local, treatment. Based on our data, we conclude that 20 Gy is sufficient in EF/IF of intermediate-stage HD following four cycles of modern polychemotherapy.}, added-at = {2014-10-16T12:05:50.000+0200}, author = {Loeffler, Markus and Diehl, Volker and Pfreundschuh, Michael and Rühl, U. and Hasenclever, Dirk and Nisters-Backes, H. and Sieber, M. and Tesch, H. and Franklin, J. and Geilen, W. and Bartels, H. and Cartoni, C. and Dölken, G. and Enzian, J. and Fuchs, R. and Gassmann, W. and Gerhartz, H. and Hagen-Aukamp, U. and Hiller, E. and Hinkelbein, H. and Hinterberger, W. and Kirchner, H. and Koch, P. and Krüger, B. and Schwarze, E. W.}, biburl = {https://www.bibsonomy.org/bibtex/248a470c97b43c231c05966f31e7e9eaf/drtester}, interhash = {0e394cee842e03bfe84265ee7741fb30}, intrahash = {48a470c97b43c231c05966f31e7e9eaf}, journal = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology}, keywords = {IMISE-Publikationen}, number = 6, pages = {2275–2287}, timestamp = {2014-12-03T00:08:52.000+0100}, title = {Dose-response relationship of complementary radiotherapy following four cycles of combination chemotherapy in intermediate-stage Hodgkin's disease}, volume = 15, year = 1997 }