Korean J Hematol 1999; 34(4):
Published online December 31, 1999
© The Korean Society of Hematology
이상원, 류백렬, 김봉석, 박연희, 김태유, 임영혁, 이영우, 홍현주, 곽진영, 강윤구
원자력병원 내과
BACKGROUND: The prognostic outlook for Hodgkin's disease has markedly improved in recent decades and 70 to 80% of patients can be cured with the modern combination chemotherapy. However, there is no standard treatment strategy according to each stage of the disease. In the present work we analysed retrospectively the therapeutic outcomes of 66 newly diagnosed patients with Hodgkin's disease treated with the strategy of Korea Cancer Center Hospital (KCCH) between 1989 and 1998. Also we studied to
identify prognostic factors influencing the therapeutic outcome of the disease.
METHODS: The treatment strategy of our institute was as follows; Patients in clinical stage IA with cervical, inguinal or mediastinal involvement and favorable histology (lymphocyte predominant) received radiotherapy without staging laparotomy. However, other patients of IA and the patients in IB, IIA, IIB, IIIA1 were recommended staging laparotomy to determine pathologic stage. The patients who were contraindicated to or refused staging laparotomy, or who were in clinical stage IIIA2, IIIB, IVA, IVB received chemotherapy. The patients in pathologic stage I or II received radiotherapy, and who in IIIA, IIIB, IIB, IV were treated with chemotherapy. The patients who have had massive tumor in any stage received additional radiotherapy following chemotherapy and who had residual lymph node after chemotherapy received additional radiotherapy to involved area.
RESULTS: Of all 66 patients, 13 patients received
radiotherapy alone and 53 patients were treated with chemotherapy +/- radiotherapy. Staging laparotomy was performed in 6 patients and pathologic stage tended to be upstaged after laparotomy. A complete response (CR) rate following treatments was reached to 81.8%(54/66, 95% C.I.=72.3~91.3%). Five-year progression free survival and overall survival rate were 59.1% and 74.3%, respectively. In prognostic factors analysis, age (P=0.0323) and performance status (P=0.0183) were the independent
prognostic factors influencing overall survival.
CONCLUSION: The outcome of Hodgkin's disease treated with our strategy was as good as that in other institutes. However, the prognosis of the patients who did not reach complete remission was poor. The prognostic factors analysis showed that age and performance status, which were not considered in establishment treatment strategy, were the independent factors influencing the outcome of Hodgkin's disease. Further studies to develop treatment strategy considering all important prognostic factors including age and performance status and to increase complete response rate and ultimately overall outcome were warranted.
Keywords Hodgkin's disease, Treatment outcome, Prognostic factor
Korean J Hematol 1999; 34(4): 549-558
Published online December 31, 1999
Copyright © The Korean Society of Hematology.
이상원, 류백렬, 김봉석, 박연희, 김태유, 임영혁, 이영우, 홍현주, 곽진영, 강윤구
원자력병원 내과
Sang Won Lee, Baek Yeol Ryoo, Bong Seog Kim, Yeon Hee Park, Tae You Kim, Young Hyuck Im, Young Woo Lee, Hyun Ju Hong, Jin Young Kwag, Yoon Koo Kang
Department of Internal Medicine,Korea Cancer Center Hospital,Seoul Korea
BACKGROUND: The prognostic outlook for Hodgkin's disease has markedly improved in recent decades and 70 to 80% of patients can be cured with the modern combination chemotherapy. However, there is no standard treatment strategy according to each stage of the disease. In the present work we analysed retrospectively the therapeutic outcomes of 66 newly diagnosed patients with Hodgkin's disease treated with the strategy of Korea Cancer Center Hospital (KCCH) between 1989 and 1998. Also we studied to
identify prognostic factors influencing the therapeutic outcome of the disease.
METHODS: The treatment strategy of our institute was as follows; Patients in clinical stage IA with cervical, inguinal or mediastinal involvement and favorable histology (lymphocyte predominant) received radiotherapy without staging laparotomy. However, other patients of IA and the patients in IB, IIA, IIB, IIIA1 were recommended staging laparotomy to determine pathologic stage. The patients who were contraindicated to or refused staging laparotomy, or who were in clinical stage IIIA2, IIIB, IVA, IVB received chemotherapy. The patients in pathologic stage I or II received radiotherapy, and who in IIIA, IIIB, IIB, IV were treated with chemotherapy. The patients who have had massive tumor in any stage received additional radiotherapy following chemotherapy and who had residual lymph node after chemotherapy received additional radiotherapy to involved area.
RESULTS: Of all 66 patients, 13 patients received
radiotherapy alone and 53 patients were treated with chemotherapy +/- radiotherapy. Staging laparotomy was performed in 6 patients and pathologic stage tended to be upstaged after laparotomy. A complete response (CR) rate following treatments was reached to 81.8%(54/66, 95% C.I.=72.3~91.3%). Five-year progression free survival and overall survival rate were 59.1% and 74.3%, respectively. In prognostic factors analysis, age (P=0.0323) and performance status (P=0.0183) were the independent
prognostic factors influencing overall survival.
CONCLUSION: The outcome of Hodgkin's disease treated with our strategy was as good as that in other institutes. However, the prognosis of the patients who did not reach complete remission was poor. The prognostic factors analysis showed that age and performance status, which were not considered in establishment treatment strategy, were the independent factors influencing the outcome of Hodgkin's disease. Further studies to develop treatment strategy considering all important prognostic factors including age and performance status and to increase complete response rate and ultimately overall outcome were warranted.
Keywords: Hodgkin's disease, Treatment outcome, Prognostic factor
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