[Intensity Modulated Hyperfractionated Accelerated Radiotherapy to Treat Advanced Head and Neck Cancer - Predictive Factors of Overall Survival]

AIM

The aim of this study was to evaluate overall survival (OS) and prognostic factors in patients ineligible for chemotherapy who were treated with a hyperfractionated accelerated schedule with simultaneous integrated boost.

MATERIAL AND METHODS

From May, 2008, to April, 2013, 122 patients with locally advanced nonmetastatic squamous laryngeal (14%), hypopharyngeal (30%), oropharyngeal (30%), and oral cavity (27%) cancer were treated at our institution. The median age, Karnofsky Performance Status (KPS), and gross tumor volume (GTV) of the patients were 63 years (range, 46-87 years), 80% (range, 50-100%), and 46 ml (range, 5-250 ml), resp. The median total dose of radiotherapy was 72.6 Gy (range, 62-77 Gy) at 1.4-1.5 Gy per fraction, and 55 Gy at 1.1 Gy per fraction was delivered for GTV (primary and lymphadenopathy) with a margin of 0.7 cm and regional lymphatic areas with a margin of 0.3 cm. The dose was delivered 2× a day, with a 6-8 hour interval between doses, via a 6 MeV linear accelerator. OS was estimated using the Kaplan-Meier method, and predictors of OS were analyzed using Cox proportional hazards regression.

RESULTS

The median duration of the radiotherapy series was 37 days (range, 32-45 days). The incidence of grade 3 acute toxicity was 62% for mucosa (oral cavity and/or pharynx) and 0% for skin. Confluent mucositis cleared in all cases within 21 days. No grade 4 or 5 toxicities were recorded. PEG was introduced before treatment in 55 patients (45%). The 1-and 2-year OS was 65% and 32%, resp. KPS less than 80% (RR 2.4, 95% CI 1.3-4.2; p = 0.004), cancers other than oropharyngeal or laryngeal cancer (RR 2.0, 95% CI 1.1-3.5; p = 0.016), and capacity of high GTV (RR 1.006, 95% CI 1.001-1.011; p = 0.017) were found to be negative prognostic factors for OS.

CONCLUSION

More than 30% of patients with poor prognosis survived for longer than 2 years. KPS before treatment was the strongest prognostic factor for better OS.Key words: head and neck cancer - radiotherapy dose fractionation - survival analysis - acceleration - hyperfractionation This work was supported by RVO-FNOs/2016 (HPV status as predictive and prognostic factor for primary and secondary head and neck cancer). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 9. 3. 2017Accepted: 19. 4. 2017.

[Stereotactic Body Radiotherapy of Prostate Cancer - Effectiveness and Toxicity]

BACKGROUND

Prostate cancer is the most prevalent cancer in males and its incidence is steadily increasing. Most cases of prostate cancer are diagnosed during the early asymptomatic period, in which case the prognosis is very good. Therapies differ widely in their efficacies and toxicities, and this is an important consideration when it comes to deciding which treatment is optimal for a particular patient. One treatment method for early stage prostate cancer is stereotactic body radiotherapy (SBRT). We present the first results obtained using this modality at our institution.

PATIENTS AND METHODS

A total of 261 patients with low or intermediate risk prostate cancer were treated with SBRT between August 2010 and July 2012. Patients received a total dose of 36.25 Gy in five fractions of 7.25 Gy every other day. The toxicity of the treatment was evaluated according to RTOG criteria. For assessment of quality of life, patients filled out a modified EPIC questionnaire (Expanded Prostate Composite index).

RESULTS

Overall survival (OS) in this study was 93.1%. Biochemical relapse free survival (bRFS) was 97.7%. As expected, OS and bRFS were worse in the group of patients with an intermediate risk of recurrence. Acute and chronic urinary and gastrointestinal RTOG toxicity was very low. Quality of life after treatment, as determined using the EPIC questionnaire, was slightly reduced immediately after treatment but returned to baseline or even improved during long term follow-up.

CONCLUSION

SBRT is an effective therapeutic modality for early prostate cancer and has acceptable rates of acute and low late toxicity.Key words: prostate cancer - stereotactic body radiotherapy - quality of life The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 5. 1. 2017Accepted: 1. 2. 2017.

[Assessment of the spiritual needs of patients in palliative care]

The appraisal and the right diagnostics of all needs and problems of patients, including the spiritual needs, are unavoidable for increase of the quality of the all-embracing nursing care. In the case of satisfying of the needs of the patients, it is important to have view the person as a unity of thebody and the soul. Identification and satisfying of the spiritual needs are not uncomplicated; moreover, spirituality does not have a target--ed and clear definition. In the palliative care, the solution and saturation of spiritual needs have a great priority, and it can be the key aspect of psychological activity. Also, medical experts are becoming aware of the meaning of spirituality as the part of psychological contentment more and more. Smaller importance is attached to measurement of spiritual needs, and in many medical institutions ends at the case history with the questions: "Are you a believer?", "Do you have any spiritual needs?". Spirituality and religion are very personal matters of every human. Many patients turn to religion to find answers to difficult questions while others find support through the spiritual beliefs outside the scope of organized religion. Mistaking of meanings of the spirituality and religionism can lead to many misunderstandings. The basic condition for the right diagnostics and satisfaction of spiritual needs are the definition of the used terms and using of standardized measurement devices in the clinical praxis. The target of summarizing study was to define the term of spirituality, to describe a lot of measurement devices these are suitable for the evaluation of human spiritual needs. For methodology for acquiring of the results of research works that are concerned with the questions of spiritual needs in case of the incurable patients, the following databases were used (2005-2013): EBSCO, Bibliographia Medica Čechoslovaca, Google Scholar, Solen - www.solen.cz, Profese on-line as the source of the data. The choice of studies were as follows the systematic overview, the summarizing essay, the qualitative and quantitative study.

[The assessment of quality of life of patients at oncological clinic - pilot study]

BACKGROUND

In oncological care the main emphasis should not be put only on prolonging a patients life, but also on its quality. The aim of the study was to assess the quality of life of patients hospitalized at the oncology clinic of the University Hospital of Ostrava (UHO), who exhausted all the anticancer treatment options. PATIENTS (SAMPLE) AND METHODS: In a pilot study the sample consisted of 93 patients from the oncological clinic of UHO with Karnofsky score < 60. A questionnaire EORTC QOL C30 was used to evaluate the quality of life.

RESULTS

The overall score of quality of life was 49%. Repeated measurement showed a significant decrease of the score to 37% (p < 0.001). Assessing the quality of life on a functioning scale, role functioning (47.3; 95% CI 42.6- 52.1) and social functioning (48.0; 95% CI 42.5- 53.5) were assessed the worst. When judging on a symptoms scale, patients reported the major problem was fatigue (48.8; 95% CI 44.8- 52.8) and pain (44.5; 95% CI 39.2- 48.8). Repeated measurement showed a statistically significant decrease in quality of life on the scale of functioning in all areas. On the symptoms scale there was similarly a decline of quality in fatigue, pain and breathlessness categories (p < 0.01). Furthermore, we observed a correlation between lower overall quality of life and a worse level of physical functions (r = 0.8047), social relationships (r = 0.7796), fatigue (r = 0.8166) and pain intensity (r = 0.8282).

CONCLUSION

Palliative care patients admitted to the oncology clinic perceive their quality of life as inferior. Home palliative care or a hospice appears to be a more suitable environment for the management of terminal care.

[The role of radiotherapy in the treatment of malignant lymphomas - recommendations of the Czech Lymphoma Study Group]

BACKGROUND

Indication of radiotherapy in lymphoma treatment is an important strategic decision requiring comprehensive expertise. It also calls for a better definition of the position of radiotherapy in clinical practice.

DESIGN

This position paper represents a consensus between hematooncologists and radiation oncologists on the role of RT in treatment of different histological types and stages of malignant lymphomas. The discussion was underway within professional societies of both specializations (Czech Lymphoma Study Group for the hematooncologists and the Society of Radiation Oncology, Biology and Physics for the radiation oncologists).

RESULTS

The consensus presented here was reached in early 2012 and draws on evidence-based medicine and clinical practice. Besides defining the role of radiotherapy in lymphoma treatment, this paper also gives specific recommendations on total doses of radiotherapy in lymphoma treatment.

CONCLUSION

These recommendations will supplement 7th edition of "Diagnostic and treatment guidelines in patients with malignant lymphoma" scheduled for publication in 2013.

Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study

BACKGROUND AND PURPOSE

The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer.

METHODS AND MATERIALS

A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV(tumor)) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV(uninvolved)) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost.

RESULTS

Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was ≤ 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%.

CONCLUSION

HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.

[HARDROCK project: parametric data collection and analysis of patients with head and neck cancer in the comprehensive cancer centre of Ostrava - role of fractionation and target volume definition in radiotherapy]

BACKGROUND

The HARDROCK project has been designed as a retrospective data collection study in a locally run database system, which fulfils the requirements on the basic version of electronic medical records of cancer patients. The diagnostic category of head and neck tumors has been selected on purpose, as it presents a major problem in the Comprehensive Cancer Centre of Ostrava, and it is relevant given the high incidence and mortality in the Moravian-Silesian Region. The target parameters of the assessment include short-term as well as long-term treatment results in patients with head and neck tumors, evaluated with standard indicators of treatment response and survival. A special emphasis is put on major treatment modalities, i.e. surgery and radiation therapy, and on related complications.

PATIENTS AND METHODS

In this article, we present a sample of collected data. The data from patients has been separated into two groups based on the time of their acquisition: data from patients treated in 2004-2005 versus patients treated in 2006-2010. This division was given by the change of treatment protocols in 2006 introducing accelerated radiotherapy with concomitant boost and expanded lymph node irradiation field compared to normofractionation and hyperfractionation regimes used before 2006.

RESULTS

Introduction of new irradiation techniques did not increase the rate of acute toxicity but slightly increased late toxicity. Further, we found a decrease of number of relapse and improved overall survival in patients with stage IV disease treated in 2006-2010.

CONCLUSION

The project results will contribute methodically to the exact evaluation of diagnostics and treatment of patients with head and neck cancer and will help to optimize their medical care.

A comparison of high-dose (HD, 500 mg) fulvestrant vs anastrozole (1 mg) as first-line treatments for advanced breast cancer: results from FIRST

Abstract #6126

Background: The estrogen-receptor (ER) antagonist fulvestrant (Faslodex™) at the approved dose (AD, 250mg) has confirmed efficacy in postmenopausal women with advanced breast cancer following recurrence or progression on an anti-estrogen. However, evidence suggests that higher doses may have greater biological and clinical activity. A recent neoadjuvant study in patients with ER+, locally advanced disease showed significantly greater reductions in Ki67 LI and ER expression for fulvestrant high dose (HD, 500 mg) compared with AD.&#x2028; Methods: FIRST (Fulvestrant fIRst-line Study comparing endocrine Treatments) is a Phase II, randomized, open-label, multicentre study comparing fulvestrant HD (500 mg/month [2×250 mg im injections] plus 500 mg on Day 14 of Month 1) vs anastrozole (1 mg/day) as first-line treatments for postmenopausal women with advanced breast cancer. Eligible patients had no prior treatment for advanced disease and ER+, evaluable disease. Patients received treatment until disease progression or an event necessitating discontinuation. The primary endpoint was clinical benefit rate (CBR), ie the proportion of patients achieving a complete response, a partial response or stable disease for ≥24 weeks. Secondary endpoints included: objective response (OR), time to progression (TTP), duration of response (DoR), duration of clinical benefit (DoCB) and tolerability (adverse events [AEs] and laboratory tests).&#x2028; Results: In total, 205 women (median age 67 years) were included (fulvestrant HD: n=102; anastrozole: n=103). Median follow-up was 6.5 months. CBR was similar between treatments: fulvestrant HD 72.5%, anastrozole 67.0% (odds ratio 1.3023, 95% confidence interval [CI] 0.7170, 2.3976, p=0.3860). OR rates were: fulvestrant HD 36%, anastrozole 35.5%. Median TTP for anastrozole: 12.5 months; fulvestrant HD: not yet reached, corresponding to a 60% longer TTP for fulvestrant HD (hazard ratio=0.6266, 95% CI 0.3929, 0.9991, p=0.0496). DoR and DoCB were also numerically longer for fulvestrant HD. Both treatments were well tolerated, with no significant differences in the incidence of pre-specified AEs or the small number of withdrawals due to AEs.&#x2028; Discussion: Fulvestrant HD offers CB and OR rates similar to those obtained with anastrozole 1 mg, with a significantly longer TTP. Fulvestrant HD was well tolerated, with no unexpected AEs. The AE profile of fulvestrant HD appears consistent with the known toxicity profile of the AD. These results are encouraging and provide further support for the improved clinical activity anticipated with fulvestrant HD. Confirmation of these findings is awaited from an ongoing Phase III, double-blind comparison of fulvestrant HD and AD (CONFIRM).

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6126.

[Clostridium difficile associated diarrhoea--problem of oncological patient?]

BACKGROUND

Clostridium difficile associated diarrhoea / disease (CDAD) is an inflammatory disease of the colon. It affects patients who have been exposed to wide-spectrum antibiotics and long-term in-patient care, with immunosuppression. The most difficult form of this disease is manifested as pseudomembranous enterocolitis, it runs fulminantly in significantevents. In recent years there has been an increase in the incidence of this disease worldwide. Several serious epidemics caused by virulent strains of Clostridium difficile have been discovered in Western Europe, North America and Asia.

PATIENTS AND METHODS

We observed an increased occurrence of this disease at our clinic during 2004-2007. A group of 36 patients with CDAD was analyzed in the article. Patients with different severity courses were identified in the group--from slightly running post-antibiotic diarrhoea to serious pancolitis with the manifestation of sepsis and MODS (multiple organ dysfunction syndrome).

MATERIALS AND METHODS

It is a retrospective analysis of a patients' group with CDAD.

RESULTS AND CONCLUSIONS

According to our experience, in the group of oncological patients, post-antibiotic clostridia diarrhoea often develops in a very complicated and protracted way. It also affects relatively young patients. Protein malnutrition and febrile neutropenia have a significant occurrence during its genesis. A higher risk of CDAD is found in the group of patients with malignant lymphomas and colorectal malignancy. 20% of our patients did not have any previous ATB exposure, so we can express the theory of oncology therapy as a predisposition factor of CDAD. The CDAD relevance in oncological patients cannot be evaluated according to leukocytosis (a significant part of febrile neutropenia in our group).The disease could require a combined causal therapy and intensive supporting treatment.There is a higher risk of heavy MODS illness course in the group of oncological patients. The article also deals with the case report of one complicated case.

Prognostic impact of bone involvement in Hodgkin lymphoma

The purpose of the study is to determine incidence and prognostic impact of osseous Hodgkin lymphoma (HL). Between 1997 and 2004, 198 patients with HL were treated at our institution. Advanced stages and nodular sclerosis histology prevailed. All patients were treated according to protocols of the German Hodgkin Study Group (GHSG). After minimum follow-up of 24 months, we retrospectively analyzed the incidence of osseous HL, treatment response and parameters of survival. We recorded 14 cases of osseous HL (7 %), always with concurrent nodal disease. Axial skeleton was most frequently involved. Eleven patients (78,5 %) achieved complete remission and three (21,5 %) progressed primarily. The patients with osseous HL had significantly lower 2-year freedom from treatment failure than the patients without bone involvement (71,4 and 92,7 %, respectively, p=0,004), with no significant difference in 2-year overall survival (85,7 and 95 %, respectively, p=0,14). On multivariate analysis, advanced stage was the only independent adverse prognostic factor. In conclusion, bone involvement is a relatively common finding in HL and is not an independent adverse prognostic factor.

Symptomatic osteoradionecrosis of pelvic bones in patients with gynecological malignancies-result of a long-term follow-up

The aim of this study was to assess the incidence and risk factors of pelvic fractures as a result of radiation therapy in women with gynecological cancer. We retrospectively reviewed 3530 female patients treated at our institute between 1980 and 1998 with megavoltage radiation with or without brachytherapy for cancer in the pelvic area. Eligible were patients with vulvar, vaginal, cervical, endometrial, and fallopian tube cancer. Median follow-up was 88 months (range 0-240). Emphasis was put on treatment-related and patient-related risk factors. Of the eligible 3155 patients, 15 developed symptomatic bone fracture caused by osteoradionecrosis, which makes an overall incidence of 0.44% The diagnosis was based on anamnesis, clinical course, and X-ray or computed tomography images. Median time of onset was 44 months (range 6-197). All patients had pain as the first symptom. The only independent predictive factor for developing osteoradionecrosis seemed to be preexistent osteoporosis. Other risk factors that are related to osteoporosis include higher age, postmenopausal status, or steroid treatment. We did not find any significant treatment-related predictive factor for pelvic osteoradionecrosis. Patients with osteoporosis are probably at the highest risk for developing osteoradionecrotic fractures after pelvic radiotherapy. More studies are needed to find out other endogenous predictive factors.

Post-treatment plasma transforming growth factor beta 1 (TGF-beta1) level predicts for late morbidity in patients with advanced head and neck cancer

Between 2001 and 2002, 29 patients with advanced inoperable squamous head and neck cancer treated with radiotherapy with or without simultaneous chemotherapy were evaluated for their plasma TGF-beta1 levels prior to the treatment, in the middle of the radiotherapy course and at the end of the treatment. Patients were assessed for treatment response and late morbidity. Predictive value of TGF-beta1 level on either of the assessed parameters was tested. From 29 eligible patients (pts), 18 achieved complete response, 8 partial response and three pts progressed primarily. After a median follow-up of 16 months we recorded 16 cases of grade >1 late morbidity. We found that post-treatment elevated plasma TGF-beta1 level predicts late morbidity grade >1 (p=0.05) rather than pre-treatment level (p=0.062). Neither pre-treatment nor post-treatment plasma TGF-beta1 level has a predictive value to the treatment response (CR vs. no CR, p=0.125 and 0.252, respectively). The post-treatment plasma TGF-beta 1 level can predict late morbidity grade >1 in advanced head and neck cancer treated with radio(chemo)therapy. This could make a basis for dose escalation in selected patients.

[Skeletal involvement in Hodgkin's lymphoma--personal experience]

PURPOSE

To assess the incidence and prognostic significance of osseous Hodgkin's lymphoma.

METHODS AND MATERIALS

The authors retrospectively analyzed 85 patients treated at their institutions between 1995-2001. They assessed the incidence of bone involvement, involved localities and basic characteristics of the subgroup (age, gender, stage, histology). All patients were treated according to the protocols of the German Hodgkin Study Group (GHSG). Treatment response, disease free- and overall survival were evaluated with special attention to predictive and prognostic significance of bone involvement.

RESULTS

From the total of 85 eligible patients 10 cases of bone involvement were recorded of who seven were diagnosed primarily and three at relapse. Most frequently involved were lumbar vertebrae. Diagnosis was based on CT and bone scan, biopsy was performed only in one case. In the evaluated subgroup, there was apparently higher incidence of advanced stage disease, other parameters did not differ from the control group. Of the 10 patients, six achieved complete remission, two uncertain complete remission and two progressed primarily. At present, eight patients are alive in complete remission, one is being treated with salvage chemotherapy and high dose therapy with autologous stem cell transplantation. One patient expired due to progressive disease. Median overall survival is 12 months.

CONCLUSION

Bone involvement is not an adverse predictive factor for treatment response in Hodgkin's lymphoma. Because of short follow-up period seems preliminary to evaluate its prognostic power for disease free- and overall survival.

[Comparison between conventional imaging methods and positron emission tomography in the treatment of Hodgkin's lymphoma]

BACKGROUND

Positron emission tomography with fluorodeoxyglucose offers the possibility to differentiate between lymphoma and nonmalignant tissue. The aim of this retrospective study was a comparison between PET and conventional imaging methods before and after therapy--during the follow-up of Hodgkin's lymphoma.

METHODS AND RESULTS

The group of 94 patients with HL underwent 180 PET examinations. PET was performed in 53 patients during initial staging of lymphoma. 119 PET studies were undertaken after therapy during the follow-up. Eight patients underwent PET examination for suspected relapse or progression of HL. Findings were verified by a follow-up in all patients and by histology in selected cases. PET and conventional imaging methods were positive in 42 of 53 (79%) patients in initial stages. The stage of the disease was changed in 7 patients (13.2%) according to PET. False negative findings were recorded in three cases and false positive in one case. Sensitivity of PET was higher compared to conventional imaging methods (92% vs 87%) in initial staging. PET and conventional imaging methods were identical in 94.9% of cases during the follow-up (77.3% negative and 17.6% positive findings). Sensitivity of PET during the follow-up after therapy was higher compared to conventional imaging methods (99.1% vs 95.7%). PET was positive in all eight cases in relapse/progression of HL and conventional imaging methods were positive in only seven of eight cases.

CONCLUSIONS

PET is a more sensitive method in initial staging, during follow-up and in suspected progression/relapse of HL than conventional imaging methods and it should be included into routine examination methods of HL.

[Late recurrence of Hodgkin's disease 20 years after initial diagnosis. Personal observation of two cases and a literature review]

Most patients with Hodgkin's disease (especially early stage disease) are successfully treated using modern treatment modalities. Disease relapse usually occurs within the first three years after initial therapy. Late relapses of Hodgkin's disease, occurring after 10 years or even later, are rare (0.6% of cases only). Their biological behaviour is different from that of early relapses, resembling primary disease. The question whether very late relapses represent a second primary disease in patients with a genetic predisposition to Hodgkin's disease rather than a relapse of the original disease remains the subject of much discussion. We report here two cases of very late relapses of Hodgkin's disease, occurring twenty years after initial treatment. Both patients were now treated by intensified chemotherapy, escalated BEACOPP. In one case, this was followed by radiotherapy of the residual tumor (40 Gy). Both patients are in complete remission.

[Treatment of Hodgkin's disease using the German Study Group protocol. Personal experience and results]

The article present an evaluation (02/1999) of the study of primary treatment of Hodgkin's disease (HD) according to the third generation of the German Hodgkin's Disease Study Group (GHSG), and our experience with this treatment strategy. HD7 study of early stages HD showed better results (fewer relapses) for combined chemo and radiotherapy than for radiotherapy alone (2x ABVD + extended field radiotherapy compared to extended field radiotherapy alone). HD8 study of intermediate stage HD did not show any difference between chemotherapy 2x (COPP + ABVD) combined with radiotherapy extended field, or involved field. Due to the long-term consequences (especially secondary neoplasm), in the current (fourth) generation protocol extended field radiotherapy in early and intermediate stage HD has been replaced by a combination of lesser toxic chemotherapy and involved field radiotherapy. HD9 study of advanced HD. The standard treatment at present of COPP/ABVD (A) was compared with the new chemotherapeutic regimen, BEACOPP baseline (B) and escalated (C). The first evaluation of this study (1996) showed better results in the case of BEACOPP. The latest evaluation showed significantly better results for the escalated version. This is best illustrated by the low percentage of disease progression (C 2%, B 8%, A 12%, p < 0.05). Therefore, DHSG is considered to be the new standard for treatment of advanced stage HD.

OUR RESULTS

Between 1995-1998, 54 patients with primary HD were treated at the FN Královaké Vinohrady, Prague according to the third generation GHSG protocol. Of these, 5 patients (9%) according to HD7, 14 (26%) according to HD8 and 35 patients (65%) according to HD9. Our results correspond to those of the whole GHSG, but they can not be statistically evaluated because of the small number of patients involved.