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Christophe Ferme - One of the best experts on this subject based on the ideXlab platform.
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abvd or beacoppbaseline along with involved field Radiotherapy in early stage hodgkin lymphoma with risk factors results of the european organisation for research and treatment of cancer eortc groupe d etude des lymphomes de l adulte gela h9 u interg
European Journal of Cancer, 2017Co-Authors: Christophe Ferme, P Carde, Pauline Brice, Olivier Casasnovas, Serge Bologna, Pieternella J Lugtenburg, Jose Thomas, Andrej Vranovsky, Reda Bouabdallah, Catherine SebbanAbstract:Purpose For early-stage Hodgkin lymphoma (HL), optimal chemotherapy regimen and the number of cycles to be delivered remain to settle down. The H9-U trial compared three modalities of chemotherapy followed by Involved-Field Radiotherapy (IFRT) in patients with stage I-II HL and risk factors (NCT00005584). Patients and methods Patients aged 15–70 years with untreated supradiaphragmatic HL with at least one risk factor (age ≥ 50, involvement of 4–5 nodal areas, mediastinum/thoracic ratio ≥ 0.35, erythrocyte sedimentation rate (ESR) ≥ 50 without B-symptoms or ESR ≥ 30 and B-symptoms) were eligible for the randomised, open label, multicentre, non-inferiority H9-U trial. The limit of non-inferiority was set at 10% for the difference between 5-year event-free survival (EFS) estimates. From October 1998 to September 2002, 808 patients were randomised to receive either the control arm 6-ABVD-IFRT (n = 276), or one of the two experimental arms: 4-ABVD-IFRT (n = 277) or 4-BEACOPPbaseline-IFRT (n = 255). Results Results in the 4-ABVD-IFRT (5-year EFS, 85.9%) and the 4-BEACOPPbaseline-IFRT (5-year EFS, 88.8%) were not inferior to 6-ABVD-IFRT (5-year EFS, 89.9%): difference of 4.0% (90%CI, -0.7%–8.8%) and of 1.1% (90%CI,-3.5%–5.6%) respectively. The 5-year overall survival estimates were 94%, 93%, and 93%, respectively. Patients treated with combined modality treatment chemotherapeutic regimen comprising doxorubicin (Adriamycin), bleomycin, vincristine (Oncovin), cyclophosphamide, procarbazine, etoposide and prednisone (BEACOPP)baseline more often developed serious adverse events requiring supportive measures and hospitalisation compared with patients receiving the chemotherapeutic regimen comprising doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD). Conclusions The trial demonstrates that 4-ABVD followed by IFRT yields high disease control in patients with early-stage HL and risk factors responding to chemotherapy. Although non-inferior in terms of efficacy, four cycles of BEACOPPbaseline were more toxic than four or six cycles of ABVD.
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Chemotherapy plus Involved-Field radiation in early-stage Hodgkin's disease
The New England journal of medicine, 2007Co-Authors: Christophe Ferme, Pauline Brice, Mars B. Van't Veer, Theodore Girinsky, Houchingue Eghbali, J.h. Meerwaldt, Chantal Rieux, Jacques Bosq, Françoise Berger, Jan WalewskiAbstract:BACKGROUND: Treatment of early-stage Hodgkin's disease is usually tailored in line with prognostic factors that allow for reductions in the amount of chemotherapy and extent of Radiotherapy required for a possible cure. METHODS: From 1993 to 1999, we identified 1538 patients (age, 15 to 70 years) who had untreated stage I or II supradiaphragmatic Hodgkin's disease with favorable prognostic features (the H8-F trial) or unfavorable features (the H8-U trial). In the H8-F trial, we compared three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) combined with doxorubicin, bleomycin, and vinblastine (ABV) plus Involved-Field Radiotherapy with subtotal nodal Radiotherapy alone (reference group). In the H8-U trial, we compared three regimens: six cycles of MOPP-ABV plus Involved-Field Radiotherapy (reference group), four cycles of MOPP-ABV plus Involved-Field Radiotherapy, and four cycles of MOPP-ABV plus subtotal nodal Radiotherapy. RESULTS: The median follow-up was 92 months. In the H8-F trial, the estimated 5-year event-free survival rate was significantly higher after three cycles of MOPP-ABV plus Involved-Field Radiotherapy than after subtotal nodal Radiotherapy alone (98% vs. 74%, P
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four abvd and involved field Radiotherapy in unfavorable supradiaphragmatic clinical stages cs i ii hodgkin s lymphoma hl preliminary results of the eortc gela h9 u trial
Blood, 2005Co-Authors: Christophe Ferme, Jean Gabarre, Andrej Vranovsky, Reda Bouabdallah, Marine Divine, F Morschhauser, Aspasia Bastardstamatoullas, Richard Delarue, Vittorina Zagonel, Jerome JaubertAbstract:The aim of the trial was to compare three modalities of chemotherapy and Involved-Field Radiotherapy (IF-RT) in adult patients with supradiaphragmatic CS I-II HL with risk factors. Patients were randomized if they presented with age ≥ 50, or CS II4–5, or A + ESR ≥ 50, or B + ESR ≥ 30, or MT ratio ≥ 0.35. The trial compared ABVD x 6 cycles and IF-RT (36–40 Gy) vs ABVD x 4 cycles and IF-RT vs BEACOPP baseline x 4 cycles and IF-RT. From October 1998 to September 2002, 808 patients were enrolled in 111 institutions from 10 European countries. The proportions of grade 3–4 chemotherapy-related hematological toxicity (mainly WBC) were 74%, 70% and 63%, respectively; That of grade 1–3 RT-related hematological toxicity were 10%, 12% and 17%, respectively. Ten (2+3+5, 1%) patients stopped chemotherapy because of toxicity and 8 (2+2+4, 1%) refused the treatment; Six (2+2+2, 1%) patients stopped Radiotherapy because of toxicity and 9 (3+1+5, 1%) refused the treatment. The proportions of patients in CR/CRu were 74%, 71% and 59% after 6, 4 ABVD and 4 BEACOPP, respectively. After a median follow-up of 57 months (range 33–81), 78 events (26 progressions, 37 relapses, 15 deaths) were observed. At July 2005, the 4-year event-free survival (EFS) and overall survival (OS) rates are as follows: | Treatment | No. Pts | CR-CRu /PR /NC-PD | 4-yr EFS | 4-yr OS | |:-----------------:| ------- | ----------------- | -------- | ------- | | 6 ABVD + IF-RT | 276 | 87% /8% /5% | 91% | 95% | | 4 ABVD + IF-RT | 277 | 86% /11% /3% | 87% | 94% | | 4 BEACOPP + IF-RT | 255 | 84% /12% /4% | 90% | 93% | | P value | | 0.607 | 0.380 | 0.978 | Overall, 42 patients have died of progressive disease (5, 7 and 7 patients), treatment-related complication (7, 5 and 2), intercurrent disease (1, 0 and 2), second malignancy (1 NHL, 0 and 1 AML) or cause unspecified (0, 3 and 1). These preliminary results indicate that a combination of 4 cycles of ABVD and IF-RT is sufficient to cure a large majority of HL patients with unfavorable early stage disease and that BEACOPP baseline has no advantage over ABVD in these patients.
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Four ABVD and Involved-Field Radiotherapy in Unfavorable Supradiaphragmatic Clinical Stages (CS) I-II Hodgkin’s Lymphoma (HL): Preliminary Results of the EORTC-GELA H9-U Trial.
Blood, 2005Co-Authors: Christophe Ferme, Jean Gabarre, Andrej Vranovsky, Reda Bouabdallah, Marine Divine, F Morschhauser, Richard Delarue, Vittorina Zagonel, Aspasia Bastard-stamatoullas, Jerome JaubertAbstract:The aim of the trial was to compare three modalities of chemotherapy and Involved-Field Radiotherapy (IF-RT) in adult patients with supradiaphragmatic CS I-II HL with risk factors. Patients were randomized if they presented with age ≥ 50, or CS II4–5, or A + ESR ≥ 50, or B + ESR ≥ 30, or MT ratio ≥ 0.35. The trial compared ABVD x 6 cycles and IF-RT (36–40 Gy) vs ABVD x 4 cycles and IF-RT vs BEACOPP baseline x 4 cycles and IF-RT. From October 1998 to September 2002, 808 patients were enrolled in 111 institutions from 10 European countries. The proportions of grade 3–4 chemotherapy-related hematological toxicity (mainly WBC) were 74%, 70% and 63%, respectively; That of grade 1–3 RT-related hematological toxicity were 10%, 12% and 17%, respectively. Ten (2+3+5, 1%) patients stopped chemotherapy because of toxicity and 8 (2+2+4, 1%) refused the treatment; Six (2+2+2, 1%) patients stopped Radiotherapy because of toxicity and 9 (3+1+5, 1%) refused the treatment. The proportions of patients in CR/CRu were 74%, 71% and 59% after 6, 4 ABVD and 4 BEACOPP, respectively. After a median follow-up of 57 months (range 33–81), 78 events (26 progressions, 37 relapses, 15 deaths) were observed. At July 2005, the 4-year event-free survival (EFS) and overall survival (OS) rates are as follows: | Treatment | No. Pts | CR-CRu /PR /NC-PD | 4-yr EFS | 4-yr OS | |:-----------------:| ------- | ----------------- | -------- | ------- | | 6 ABVD + IF-RT | 276 | 87% /8% /5% | 91% | 95% | | 4 ABVD + IF-RT | 277 | 86% /11% /3% | 87% | 94% | | 4 BEACOPP + IF-RT | 255 | 84% /12% /4% | 90% | 93% | | P value | | 0.607 | 0.380 | 0.978 | Overall, 42 patients have died of progressive disease (5, 7 and 7 patients), treatment-related complication (7, 5 and 2), intercurrent disease (1, 0 and 2), second malignancy (1 NHL, 0 and 1 AML) or cause unspecified (0, 3 and 1). These preliminary results indicate that a combination of 4 cycles of ABVD and IF-RT is sufficient to cure a large majority of HL patients with unfavorable early stage disease and that BEACOPP baseline has no advantage over ABVD in these patients.
Satoaki Nakamura - One of the best experts on this subject based on the ideXlab platform.
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Patterns of failure associated with involved field Radiotherapy in patients with clinical stage I thoracic esophageal cancer. Japanese journal of clinical oncology. 2011; 41(8):1007–1012. doi: 10.1093/jjco/hyr069 PMID: 21665908
2016Co-Authors: Yoshifumi Kawaguchi, Kinji Nishiyama, Ken Miyagi, Osamu Suzuki, Yuri Ito, Satoaki NakamuraAbstract:Objective: To analyze the patterns of the first sites of failure in patients with clinical stage I thoracic esophageal cancer after involved field Radiotherapy and to determine whether elec-tive nodal irradiation is necessary for these patients. Materials and Methods: Between 2000 and 2007, 68 patients aged 43–84 years with clini-cal stage I thoracic esophageal cancer received definitive Radiotherapy. The radiation field included the primary tumor with a 3-cm margin in the cranio-caudal direction. Patterns of lymph node failure were classified according to the first sites of failure. In-field, regional and distant lymph node failures were defined as lymph node failures within the irradiated area, within the mediastinum or perigastric area beyond the irradiated area, and outside the regional lymph nodes, respectively. Results: The 3 year overall and disease-free survival rates were 76 and 66%, respectively (median follow-up: 42 months). Twenty-two of the 68 patients exhibited treatment failure. Local failure with or without recurrence in other sites was observed in 11 patients, lymph node failure in 10 patients, and distant metastasis in 1. Of the 10 patients with lymph node failure, sites of failure were in-field in 1 patient, in-field and distant in 1, regional in 3, distan
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Patterns of Failure Associated with Involved Field Radiotherapy in Patients with Clinical Stage I Thoracic Esophageal Cancer
Japanese journal of clinical oncology, 2011Co-Authors: Yoshifumi Kawaguchi, Kinji Nishiyama, Ken Miyagi, Osamu Suzuki, Yuri Ito, Satoaki NakamuraAbstract:Objective: To analyze the patterns of the first sites of failure in patients with clinical stage I thoracic esophageal cancer after involved field Radiotherapy and to determine whether elective nodal irradiation is necessary for these patients. Materials and Methods: Between 2000 and 2007, 68 patients aged 43‐84 years with clinical stage I thoracic esophageal cancer received definitive Radiotherapy. The radiation field included the primary tumor with a 3-cm margin in the cranio-caudal direction. Patterns of lymph node failure were classified according to the first sites of failure. In-field, regional and distant lymph node failures were defined as lymph node failures within the irradiated area, within the mediastinum or perigastric area beyond the irradiated area, and outside the regional lymph nodes, respectively. Results: The 3 year overall and disease-free survival rates were 76 and 66%, respectively (median follow-up: 42 months). Twenty-two of the 68 patients exhibited treatment failure. Local failure with or without recurrence in other sites was observed in 11 patients, lymph node failure in 10 patients, and distant metastasis in 1. Of the 10 patients with lymph node failure, sites of failure were in-field in 1 patient, in-field and distant in 1, regional in 3, distant in 2 and distant and regional in 3. Conclusions: Involved field Radiotherapy did not result in significant incidence of regional lymph node failure in clinical stage I thoracic esophageal cancer patients. However, further investigation is needed to establish the optimal Radiotherapy field for clinical stage I thoracic esophageal cancer.
Dennis E. Hallahan - One of the best experts on this subject based on the ideXlab platform.
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High dose chemotherapy and stem cell rescue for aggressive non-Hodgkin's lymphoma: Pattern of failure and implications for Involved-Field Radiotherapy
International journal of radiation oncology biology physics, 1997Co-Authors: Arno J. Mundt, Stephanie F. Williams, Dennis E. HallahanAbstract:Purpose: To evaluate the pattern of failure and outcome of patients with aggressive non-Hodgkin's lymphoma (NHL) undergoing high-dose chemotherapy (HDCT) and autologous stem cell rescue (SCR) with an emphasis on the role of adjuvant Involved-Field Radiotherapy (IFRT). Method and Materials: Fifty-three adult patients with aggressive NHL (46 intermediate-and 7 high-grade) underwent HDCT with SCR. All patients underwent induction chemotherapy prior to high dose intensification. Seven (13.2%) received IFRT to 10 disease sites either prior to or following HDCT. Indication included symptomatic or bulky disease, persistent disease, or to consolidate a complete response (CR). Sites of relapse were designated as old (involved prior to HDCT) or new (previously uninvolved). Median followup was 20.1 months (range, 1.2-69.3 months). Results: The 4-year actuarial progression-free (PFS) and cause-specific (CSS) survivals of the entire group were 30.0 and 50.2%, respectively. Excluding toxic deaths, 24 patients (52.2%) relapsed. Sixteen (34.7%) failed in old and 15 (32.6%) in new sites. Patients treated with IFRT had a lower rate of relapse in old sites (0 vs. 41%) (p = 0.04) than patients treated with HDCT alone. Of the 141 sites present prior to induction, 127 (90.1%) were amenable to IFRT. Excluding irradiated sites, the overall 4-year local control (LC) of all amenable sites was 61.1%. Amenable sites failing to achieve a CR to induction had a poorer LC (32.0 vs. 95.1%) (p < 0.0001) than sites in CR. The 4-year LC of sites failing to achieve a CR to HDCT was 29.4%. Adjuvant IFRT improved the 4-year LC of all sites (100 vs. 61.1%) (p = 0.05), persistent sites following induction (100 vs. 32.0%) (p = 0.01) and persistent sites following HDCT (100 vs. 29.4%) (p = 0.01). Adjuvant IFRT was not associated with any untoward acute or late toxicity. Conclusions: The predominant site of relapse in patients with aggressive NHL undergoing HDCT and SCR is in sites of disease present prior to HDCT. However, the risk of relapse of prior disease sites varies greatly depending upon their response to chemotherapy. Sites at greatest risk are those failing to achieve a CR to induction regardless of their response to HDCT. IFRT is capable of reducing the high risk of relapse in these sites, the majority of which are amenable to IFRT. These results demonstrate a rationale for and possible benefit to IFRT in patients with aggressive NHL undergoing HDCT and SCR.
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Patterns of failure following high-dose chemotherapy and autologous bone marrow transplantation with involved field Radiotherapy for relapsed/refractory Hodgkin's disease.
International journal of radiation oncology biology physics, 1995Co-Authors: Arno J. Mundt, Gregory S. Sibley, Stephanie F. Williams, Dennis E. Hallahan, Jaishanker Nautiyal, Ralph R. WeichselbaumAbstract:Purpose : To evaluate the patterns of failure and outcome of patients undergoing high-dose chemotherapy and autologous bone marrow transplantation for relapsed/refractory Hodgkin's disease with emphasis on the impact of Involved-Field Radiotherapy. Method and Materials : Fifty-four adult patients with refractory (25) or relapsed (29) Hodgkin's disease underwent high-dose chemotherapy with either autologous bone marrow (32) or peripheral stem cell (23) transplantation. Twenty patients received Involved-Field Radiotherapy either prior to (7) or following (13) high-dose chemotherapy. Patients treated prior to the high-dose chemotherapy received radiation to bulky or symptomatic sites, and those treated following the transplantation were treated to sites of disease persistence (10) or to consolidate a complete response (3). Twenty-six patients had purely nodal disease, 10 had lung involvement, 7 liver, 5 bon, and 3 bone marrow. A total of 147 sites were present prior to high-dose chemotherapy. Nineteen were bulky (≥5 cm), and 42 arose in a previous Radiotherapy field. Results : Twenty-five of the 54 patients (46.3% relapsed. Seventeen (68.0%) relapsed in sites of disease present prior to high-dose chemotherapy. Patients treated with Involved-Field Radiotherapy had a lower rate of relapse in sites of prior disease involvement (26.3 vs. 42.8%) (p < 0.05) than those not treated with Radiotherapy. Twenty-one patients had disease persistence following high-dose chemotherapy, of which 10 received Involved-Field Radiotherapy and were converted to a complete response. Patients with disease persistence who received Involved-Field Radiotherapy had a better progression-free survival (40.0 vs. 12.1%) (p = 0.04) than those who did not. Moreover, the patients converted to a complete response had similar progression-free and cause-specific survival as those patients achieving a complete response with high-dose chemotherapy alone. Of the initial 147 sites, 143 (97.3%) were amenable to Involved-Field radiation therapy. The addition of Involved-Field Radiotherapy improved the 5-year local control of all sites (p = 0.008), nodal sites (p = 0.01), and sites of disease persistence (p = 0.0009). Conclusions : Patients with relapsed/refractory Hodgkin's disease undergoing high-dose chemotherapy and autologous bone marrow rescue have a high rate of relapse in sites of prior disease involvement Involved-Field Radiotherapy is capable of improving the control of these sites, the majority of which are amenable to Radiotherapy. In addition, the use of Radiotherapy to sites of disease persistence following high-dose chemotherapy may improve the outcome of these patient.
Yoshifumi Kawaguchi - One of the best experts on this subject based on the ideXlab platform.
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Patterns of failure associated with involved field Radiotherapy in patients with clinical stage I thoracic esophageal cancer. Japanese journal of clinical oncology. 2011; 41(8):1007–1012. doi: 10.1093/jjco/hyr069 PMID: 21665908
2016Co-Authors: Yoshifumi Kawaguchi, Kinji Nishiyama, Ken Miyagi, Osamu Suzuki, Yuri Ito, Satoaki NakamuraAbstract:Objective: To analyze the patterns of the first sites of failure in patients with clinical stage I thoracic esophageal cancer after involved field Radiotherapy and to determine whether elec-tive nodal irradiation is necessary for these patients. Materials and Methods: Between 2000 and 2007, 68 patients aged 43–84 years with clini-cal stage I thoracic esophageal cancer received definitive Radiotherapy. The radiation field included the primary tumor with a 3-cm margin in the cranio-caudal direction. Patterns of lymph node failure were classified according to the first sites of failure. In-field, regional and distant lymph node failures were defined as lymph node failures within the irradiated area, within the mediastinum or perigastric area beyond the irradiated area, and outside the regional lymph nodes, respectively. Results: The 3 year overall and disease-free survival rates were 76 and 66%, respectively (median follow-up: 42 months). Twenty-two of the 68 patients exhibited treatment failure. Local failure with or without recurrence in other sites was observed in 11 patients, lymph node failure in 10 patients, and distant metastasis in 1. Of the 10 patients with lymph node failure, sites of failure were in-field in 1 patient, in-field and distant in 1, regional in 3, distan
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Patterns of Failure Associated with Involved Field Radiotherapy in Patients with Clinical Stage I Thoracic Esophageal Cancer
Japanese journal of clinical oncology, 2011Co-Authors: Yoshifumi Kawaguchi, Kinji Nishiyama, Ken Miyagi, Osamu Suzuki, Yuri Ito, Satoaki NakamuraAbstract:Objective: To analyze the patterns of the first sites of failure in patients with clinical stage I thoracic esophageal cancer after involved field Radiotherapy and to determine whether elective nodal irradiation is necessary for these patients. Materials and Methods: Between 2000 and 2007, 68 patients aged 43‐84 years with clinical stage I thoracic esophageal cancer received definitive Radiotherapy. The radiation field included the primary tumor with a 3-cm margin in the cranio-caudal direction. Patterns of lymph node failure were classified according to the first sites of failure. In-field, regional and distant lymph node failures were defined as lymph node failures within the irradiated area, within the mediastinum or perigastric area beyond the irradiated area, and outside the regional lymph nodes, respectively. Results: The 3 year overall and disease-free survival rates were 76 and 66%, respectively (median follow-up: 42 months). Twenty-two of the 68 patients exhibited treatment failure. Local failure with or without recurrence in other sites was observed in 11 patients, lymph node failure in 10 patients, and distant metastasis in 1. Of the 10 patients with lymph node failure, sites of failure were in-field in 1 patient, in-field and distant in 1, regional in 3, distant in 2 and distant and regional in 3. Conclusions: Involved field Radiotherapy did not result in significant incidence of regional lymph node failure in clinical stage I thoracic esophageal cancer patients. However, further investigation is needed to establish the optimal Radiotherapy field for clinical stage I thoracic esophageal cancer.
Joachim Yahalom - One of the best experts on this subject based on the ideXlab platform.
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the role of fdg pet imaging and involved field Radiotherapy in relapsed or refractory diffuse large b cell lymphoma
Bone Marrow Transplantation, 2009Co-Authors: Bradford S Hoppe, Andrew D. Zelenetz, Craig H Moskowitz, Zhigang Zhang, Jocelyn C Maragulia, R D Rice, Anne S Reiner, Paul A Hamlin, Joachim YahalomAbstract:We examined the role of fluorodeoxyglucose-positron emission tomography (FDG-PET) and the addition of involved field Radiotherapy (IFRT) as potential modifiers of salvage therapy. From January 2000 to June 2007, 83 patients with chemosensitive relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) underwent FDG-PET scans following second-line chemotherapy before high-dose therapy with autologous stem cell rescue (HDT/ASCR). We evaluated the prognostic value of having a negative FDG-PET scan before HDT/ASCR and whether IFRT improved the outcomes. Median follow-up was 45 months, and the 3-year PFS, disease-specific survival (DSS) and OS were 72, 80 and 78%, respectively. Multivariate analysis revealed that a positive FDG-PET scan had worse PFS (hazard ratio=(HR) 3.4; P=0.014), DSS (HR=7.7; P=0.001) and OS (HR=5.4; P=0.001), and that patients not receiving IFRT had worse PFS (HR=2.7; P=0.03) and DSS (HR=2.8, P=0.059). Patients who received IFRT had better local control with fewer relapses within prior involved sites compared with those that did not receive IFRT (P=0.006). These outcomes confirm the important prognostic value of FDG-PET scans before undergoing HDT/ASCR. It also suggests that the role of IFRT should be evaluated further.
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involved field Radiotherapy before high dose therapy and autologous stem cell rescue in diffuse large cell lymphoma long term disease control and toxicity
Journal of Clinical Oncology, 2008Co-Authors: Bradford S Hoppe, Andrew D. Zelenetz, Craig H Moskowitz, Daniel A Filippa, Chaya S Moskowitz, Tarun Kewalramani, Joachim YahalomAbstract:Purpose To analyze outcome, prognostic factors, and toxicities in patients with diffuse large-cell lymphoma (DLCL) who received Involved-Field Radiotherapy (IFRT) before high-dose chemotherapy with autologous stem-cell rescue (ASCR). Patients and Methods Between January 1990 and August 2006, 164 patients with relapsed or refractory DLCL received IFRT at Memorial Sloan-Kettering Cancer Center (New York, NY) before high-dose chemotherapy and ASCR. IFRT was delivered to involved sites measuring more than 5 cm or to sites with residual disease more than 2 cm. Radiotherapy was administered in 1.5-Gy fractions twice daily to a total dose of 30 Gy. Progression-free survival and overall survival were calculated, and short- and long-term toxicity was assessed according to National Cancer Institute Common Toxicity Criteria (version 2.0). Median follow-up was 60 months (range, 2 to 187 months). Results Two- and 5-year progression-free survival was 62% and 53%; 2- and 5-year overall survival was 67% and 58%, respecti...
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Relapsed and Primary Refractory Diffuse Large B-Cell Lymphoma: Improving Outcome by Incorporating Involved Field Radiotherapy into a Comprehensive Second-Line High-Dose Therapy Strategy.
Blood, 2007Co-Authors: Bradford S Hoppe, Joachim Yahalom, Jocelyn C Maragulia, Paul A Hamlin, Daniel A Filippa, Tarun Kewalramani, David Rice, Alandra Weaver, Craig H MoskowitzAbstract:Primary refractory or relapse patients (pts) who have not achieved complete response after salvage or re-induction therapy carry poor prognosis even if additional high-dose chemotherapy is given. In a cohort of 171 pts with relapsed or refractory DLBCL, treated at MSKCC between 1/1/1994 to 9/1/2006 with ICE (ifosfamide, carboplatin, etoposide)-based salvage chemotherapy (44% received ICE+ Rituximab) followed by high dose chemotherapy with autologous stem cell rescue (HDT/ASCR), all pts had post-ICE functional imaging (FI) (Gallium or PET scan). All pts were required to have improvement on CT scan after ICE to be eligible for HDT/ASCR. Involved field Radiotherapy (IFRT) was given (prior to HDT/ASCR) to sites of previously unirradiated bulky disease (>5 cm) or to sites with residual nodal masses of more than 2 cm in size following ICE. IFRT was administered within two weeks in 1.5 Gy fractions twice daily to a total dose of 30 Gy if given alone, or to a dose of 18 Gy if given in combination with 12 Gy fractionated total body irradiation. At a median follow-up of 57 months for surviving pts, there were no treatment-related deaths, and the 5-year progression-free survival (PFS) and overall survival (OS) for the entire cohort was 51% and 57%, respectively. Following ICE-based cytoreduction, FI was positive in 65 pts (38%) and they had an inferior 5 yr PFS (30% vs 61%, p=0.001) and OS (37% vs 67%, p
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Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Detected by Clonotypic Polymerase Chain Reaction Despite Continuous Pathologic Remission Induced by Involved-Field Radiotherapy
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005Co-Authors: Ariela Noy, Joachim Yahalom, Leah Zaretsky, Ian Brett, Andrew D. ZelenetzAbstract:Purpose Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is indolent and often associated with Helicobacter pylori bacterial infection. H pylori–independent MALT develops either in the absence of the bacteria or persists after bacterial eradication. We have previously demonstrated long-term pathologic remission after Involved-Field Radiotherapy therapy (IFRT). We determined molecular remission status by clonotypic polymerase chain reaction (PCR). Patients and Methods Twenty-four consecutive patients with stage I to IIE gastric MALT lymphoma who obtained a pathologic remission after IFRT alone were evaluated. All had at least two follow-up endoscopic gastroduodenal biopsies at Memorial Sloan-Kettering Cancer Center. IFRT median dose was 30 Gy (range, 28.5 to 43.5 Gy). Post-treatment biopsies were subjected to semi-nested clonotypic PCR. Results All patients obtained a complete response based on routine immunohistochemical pathologic analysis of random post-treatment gastric biopsies. Median follow...
