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Radiotherapy Alone Versus Combined-Modality Therapy for Initial Treatment of Early Stage Hodgkin's Lymphoma

Hanan Shawky Gamal El-Deen^* and Amr Abd- El Aziz Ghannam

Clinical Oncology Department, Tanta University Hospital, Tanta, Egypt

hannshawky@yahoo.com

Abstract: Purpose: Retrospective analysis and comparison of the efficacy, feasibility and long term side effects, of combined-modality therapy (CMT) versus radiotherapy alone as front-line therapy in early stage Hodgkin's lymphoma (HL). Patients and Methods: Between January 1998 and January 2008, 115 patients with early stage IA and IIA Hodgkin's lymphoma were allocated to receive either radiotherapy alone (n= 43), with a mean dose, of 40 Gy, or radiochemotherapy (n = 72) with low dose involved field radiotherapy (LDIFRT), with a mean dose, of LDIFRT of 30 Gy. The primary endpoint of this study was overall and disease -free survival time at 5 and 10 years in both treatment arms. Secondary endpoints included treatment response, tolerability and late treatment related events of each schedule. Kaplan-Meier method estimated overall survival (OS) and disease -free survival (DFS). Log rank test compared survival curves with p value ≤ 0.05 considered significant. Results: A total of 115 eligible patients were analyzed. Adverse prognostic factors were almost higher in the CMT group. Both treatment protocols could be delivered in an optimal dose and without significant delay. After 10 years of follow-up CMT produced significantly less nausea and vomiting (p = 0.023), as well as less incidence of second malignancy (p = 0.001), also less pulmonary toxicity (p = 0.11), Hyporthyroidism (p = 0.07), cardiac complications (p = 0.38), and Hyperthyroidism (p = 0.19) but without statistical significance. For CMT arm, the 10-years DFS and OS were 87% and 83%, respectively, compared with 75% and 71%, respectively, for the radiotherapy alone arm. Elevated ESR > 50 (p = <0.001), stage IIA disease (p = 0.01), and involvement of > 3 lymph node sites (p = 0.003) had statistically significant adverse effect on the OAS. However age, sex, pathological subtype, and bulky mediastinum had no statistically significant effect on the OAS (all p = NS). Univariate analysis of factors that might affect DFS showed that patients with involvement of < 3 lymph node sites (p = 0.007), ESR < 50 (p = 0.001) and stage IA disease (p = 0.01), had statistically significant longer DFS. Conclusion: In patients with early stage HL, a CMT results in less incidence of late treatment related events, and has a trend toward better DFS and OS, when compared with radiotherapy alone, however a larger number of patients and longer follow-up is required for a definitive statement on survival.
[Hanan Shawky Gamal El-Deen and Amr Abd- El Aziz Ghannam. Radiotherapy Alone Versus Combined-Modality Therapy for Initial Treatment of Early Stage Hodgkin's Lymphoma. Cancer Biology. 2012;2(1):1-10]. (ISSN: 2150-1041). http://www.cancerbio.net. 1

doi:10.7537/marscbj020112.01

Key words: early stage IA and IIA Hodgkin’s lymphoma, combined-modality therapy, radiotherapy alone, prognostic factors, toxicity.

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Cancer and Prostate Epithelial Stem Cell

Mark H Smith

Queens, New York 11418, USA. mark20082009@gmail.com

Abstract: Cancer is the cells that grow out of control. Cancer cells can also invade other tissues. Growing out of control and invading other tissues are what makes a cell a cancer cell. Involved in more than 100 diseases, the cancer can cause serious illness and death. Normally, the cells become cancer cells because of DNA damage. This material is a literature collection of the researches on the cancer and the transcription factor nanog.

[Smith MH. Cancer and Prostate Epithelial Stem Cell. Cancer Biology 2012;2(1):11-14]. (ISSN: 2150-1041). http://www.cancerbio.net. 2

doi:10.7537/marscbj020112.02

Keywords: cancer; biology; life; disease; research; literature; stem cell

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Cancer and Environment Literature

Mark H Smith

Queens, New York 11418, USA. mark20082009@gmail.com

Abstract: This material is a literature collection of the researches on the cancer and the environment.

[Smith MH. Cancer and Environment Literature. Cancer Biology 2012;2(1):15-34]. (ISSN: 2150-1041). http://www.cancerbio.net. 3

doi:10.7537/marscbj020112.03

Keywords: cancer; biology; life; disease; research; literature

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Cancer and Epidemiology literature

Mark H Smith

Queens, New York 11418, USA. mark20082009@gmail.com

Abstract: This material is a literature collection of the researches on the cancer and the epidemiology.

[Smith MH. Cancer and Epidemiology literature. Cancer Biology 2012;2(1):35-73]. (ISSN: 2150-1041). http://www.cancerbio.net. 4

doi:10.7537/marscbj020112.04

Keywords: cancer; biology; life; disease; research; literature; epidemiology

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Literature Introducing of Cancer and Animal Studies

Mark H Smith

Queens, New York 11418, USA. mark20082009@gmail.com

Abstract: Cancer is the cells that divide and grow uncontrollably, which form malignant tumors, and could exist in all parts of the human body. This material introduces some literature decriptions on the animal model application in the cancer researches.

[Smith MH. Literature Introducing of Cancer and Animal studies. Cancer Biology 2012;2(1):74-86]. (ISSN: 2150-1041). http://www.cancerbio.net. 5

doi:10.7537/marscbj020112.05

Keywords: cancer; biology; research; life; disease; animal

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Bladder Cancer Literatures

Mark H Smith

Queens, New York 11418, USA. mark20082009@gmail.com

Abstract: This material is a literature collection of the researches on the cancer and the bladder.

[Smith MH. Bladder Cancer Literatures. Cancer Biology 2012;2(1):87-176]. (ISSN: 2150-1041). http://www.cancerbio.net. 6

doi:10.7537/marscbj020112.06

Keywords: cancer; biology; life; disease; research; literature; bladder

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Bone Cancer Literatures

Mark H Smith

Queens, New York 11418, USA. mark20082009@gmail.com

Abstract: This material is a literature collection of the researches on the cancer and the bone.

[Smith MH. Bone Cancer Literatures. Cancer Biology 2012;2(1):177-215]. (ISSN: 2150-1041). http://www.cancerbio.net. 7

doi:10.7537/marscbj020112.07

Keywords: cancer; biology; life; disease; research; literature; bone

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Cervical Cancer

Mark H Smith

Queens, New York 11418, USA. mark20082009@gmail.com

Abstract: This material is a literature collection of the researches on the cervical cancer.

[Smith MH. Cervical Cancer. Cancer Biology 2012;2(1):216-257]. (ISSN: 2150-1041). http://www.cancerbio.net. 8

doi:10.7537/marscbj020112.08

Keywords: cancer; biology; life; disease; research; literature; cervical

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