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• W2595576915 abstract "Treatment of stage IIB bulky Hodgkin lymphoma in patients is controversial, with wide variation in treatment strategies employed by different institutions. For example, some large international studies have excluded such patients from the early-unfavorable group, instead grouping them with advanced-stage disease; yet, in practice and according to published guidelines, stage IIB bulky patients can be managed using an early-stage treatment paradigm with combined modality treatment consisting of chemotherapy followed by consolidative radiation. We reviewed our institutional experience with patients with stage IIB bulky disease to evaluate whether this group of patients could be appropriately stratified and treated with combined modality treatment, similar to early-stage patients by describing their long-term clinical outcomes and by comparing them with patients with stage III or IV disease. We identified 149 consecutive patients with stage IIB bulky Hodgkin lymphoma treated from 1971 and 2012. Clinical, pathologic, and treatment characteristics were extracted from medical records. Actuarial overall and disease-specific survival was calculated using the Kaplan-Meier method. Independent factors associated with these outcomes were identified using a multivariate Cox regression model. Outcomes were further compared against a subgroup of 126 patients with advanced-stage disease treated from 1971 and 2009. Median overall survival (OS) time for patients with stage IIB bulky Hodgkin lymphoma was 322.4 months (vs 145.9 months for stage III/IV patients; P = .005). The 5-year OS rate for stage IIB bulky patients who received combined-modality ABVD and radiation was 89.1%; the 5-year relapse-free survival rate was 79.1%. On multivariate analysis, age <40 years (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.16–0.62, P = .001), receipt of ABVD (vs MOPP; HR = 0.32, 95% CI = 0.11–0.80, P = .014), and radiation dose ≥ 30.1 Gy (HR = 0.26, 95% CI = 0.11–0.67, P = .007) were associated with improved OS. Cardiac events (n = 11) and secondary malignancies (n = 11) all occurred in patients treated before 1995. A subgroup analysis demonstrated significantly improved outcomes in IIB bulky versus advanced stage patients (median OS: 322.4 vs 145.9 months, P = .008). The trend of improved outcomes in IIB bulky patients was especially evident in the modern era (>1995; P = .004). In this cohort, patients with stage IIB bulky Hodgkin lymphoma demonstrated excellent outcomes after treatment with combined-modality ABVD and radiation therapy, although inferior but almost comparable to early-stage disease. Temporal trends in treatment strategies have changed substantially, with concomitant improvements in disease outcomes and long-term toxicities." @default.
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• W2595576915 date "2015-11-01" @default.
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• W2595576915 title "Outcomes After Chemotherapy Followed by Radiation for Stage IIB Hodgkin Lymphoma With Bulky Disease" @default.
• W2595576915 doi "https://doi.org/10.1016/j.ijrobp.2015.07.197" @default.
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