Información sobre riesgo, prevención, detección, síntomas, diagnosis, tratamiento y apoyo para el cáncer.
Información sobre el tratamiento del cáncer incluyendo quirúrgica, quimioterapia, radioterapia, estudios clínicos, terapia con protón, medicina complementaria avanzadas.
OncoLink se complace en ofrecer una amplia lista de lista completa de los agentes quimioterapéuticos más comúnmente usados??. Esta guía de referencia incluye información sobre la forma en que cada fármaco se administra, cómo funcionan, y los pacientes los efectos secundarios comunes pueden experimentar.
Maneras que los pacientes de cáncer y las personas que le cuidan puedan enfrentar el cáncer, los efectos secundarios, nutrición, cuestiones en general sobre el apoyo para el cáncer, duelo/decisiones sobre el termino de vida, y experiencias compartidas por sobrevivientes.
Reviewer: John Wilson, MD
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 11 de octubre del 2004
Presenter: Ruhl, Ursula
Presenter's Affiliation: Radiation Oncology, Moabit Hospital, Berlin, Germany
Type of Session: Plenary
Materials and Methods
The appropriate dose of radiation still must be addressed. Data from other studies suggest that a dose of 15-25 Gy provides excellent local control, and 30-35 Gy are no longer needed for involved field radiotherapy. The German data confirm a published CCG trial, 9542, of risk adapted COPP-ABV (Cyclophosphamice, Oncovin, Procarbazine, Prednisone, Adriamycin, Bleomycin, and Vinblastine) chemotherapy. In this CCG trial, those achieving a CR to chemotherapy were then randomized to receive or not receive 21 Gy involved field radiotherapy. The CCG study actually showed the value of radiotherapy for the group as a whole, and in each individual risk group: low, intermediate, and high risk. However, there were different definitions of low risk between the German and CCG studies. The CCG included stage I and IIA patients like the German study, but excluded those with other adverse features such as hilar LAD, involvement of more than four nodal regions, mediastinal tumor greater than 1/3 the intrathoracic diameter, and nodal aggregate greater than 10cm, so therefore, the low risk criteria was more, not less stringent in the CCG compared to the GPOH study. The CCG study also used slightly different chemotherapy, with COPP/ABV for the low and intermediate risk groups, and cytarabine and etoposide added on in the high risk group, so the GPOH study did not use vinblastine or cytarabine as the CCG study did. Finally, the GPOH study assigned therapy, while CCG study was randomized, which gives the CCG study more credibility. It may be that the CCG data reanalyzed using a different definition of low risk could show less of a difference with and without radiation.
The data for low risk patients are controversial regarding the need for radiation. People at Stanford, Harvard, and St Jude have treated children with low risk Hodgkin's disease with four cycles of VAMP (Vinblastine, Adria, Methtrexate, and Prednisone) and response based involved field radiotherapy (15 Gy to CR and 25.5 Gy to PR after VAMP x 2), with a 5 yr EFS of 93% (J Clin Oncol. 2002 Jul 15;20(14):3051-3.) In a new study at Stanford, they use PET + CT to assess response, and omit radiation in those who achieve a rapid, early complete response after 2 cycles of VAMP and give those with a PR 25.5 Gy involved field radiotherapy. This study may answer the question regarding the need for radiotherapy in low risk pediatric Hodgkin's disease. In conclusion, the value of RT for those with low risk disease still remains unclear, but children with intermediate and high risk disease should routinely be irradiated.
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