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      Use of appropriate initial treatment among adolescents and young adults with cancer.

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          Abstract

          There has been little improvement in the survival of adolescent and young adult (AYA) cancer patients aged 15 to 39 years relative to other age groups, raising the question of whether such patients receive appropriate initial treatment.

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          The distinctive biology of cancer in adolescents and young adults.

          Archie Bleyer, Ronald Barr, Brandon Hayes-Lattin … (2008)
          One explanation for the relative lack of progress in treating cancer in adolescents and young adults is that the biology of malignant diseases in this age group is different than in younger and older persons, not only in the spectrum of cancers but also within individual cancer types and within the patient (host). Molecular, epidemiological and therapeutic outcome comparisons offer clues to this distinctiveness in most of the common cancers of adolescents and young adults. Translational and clinical research should not assume that the biology of cancers and patients is the same as in other age groups, and treatment strategies should be tailored to the differences.
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            Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma.

            Bernd Dörken, Andreas Engert, Richard Greil … (2010)
            Whether it is possible to reduce the intensity of treatment in early (stage I or II) Hodgkin's lymphoma with a favorable prognosis remains unclear. We therefore conducted a multicenter, randomized trial comparing four treatment groups consisting of a combination chemotherapy regimen of two different intensities followed by involved-field radiation therapy at two different dose levels. We randomly assigned 1370 patients with newly diagnosed early-stage Hodgkin's lymphoma with a favorable prognosis to one of four treatment groups: four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy of radiation therapy (group 1), four cycles of ABVD followed by 20 Gy of radiation therapy (group 2), two cycles of ABVD followed by 30 Gy of radiation therapy (group 3), or two cycles of ABVD followed by 20 Gy of radiation therapy (group 4). The primary end point was freedom from treatment failure; secondary end points included efficacy and toxicity of treatment. The two chemotherapy regimens did not differ significantly with respect to freedom from treatment failure (P=0.39) or overall survival (P=0.61). At 5 years, the rates of freedom from treatment failure were 93.0% (95% confidence interval [CI], 90.5 to 94.8) with the four-cycle ABVD regimen and 91.1% (95% CI, 88.3 to 93.2) with the two-cycle regimen. When the effects of 20-Gy and 30-Gy doses of radiation therapy were compared, there were also no significant differences in freedom from treatment failure (P=1.00) or overall survival (P=0.61). Adverse events and acute toxic effects of treatment were most common in the patients who received four cycles of ABVD and 30 Gy of radiation therapy (group 1). In patients with early-stage Hodgkin's lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy is as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy. Long-term effects of these treatments have not yet been fully assessed. (Funded by the Deutsche Krebshilfe and the Swiss Federal Government; ClinicalTrials.gov number, NCT00265018.)
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              Morbidity and mortality in long-term survivors of Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study.

              Sharon M Castellino, Ann Geiger, Ann C Mertens … (2011)
              The contribution of specific cancer therapies, comorbid medical conditions, and host factors to mortality risk after pediatric Hodgkin lymphoma (HL) is unclear. We assessed leading morbidities, overall and cause-specific mortality, and mortality risks among 2742 survivors of HL in the Childhood Cancer Survivor Study, a multi-institutional retrospective cohort study of survivors diagnosed from 1970 to 1986. Excess absolute risk for leading causes of death and cumulative incidence and standardized incidence ratios of key medical morbidities were calculated. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of risks for overall and cause-specific mortality. Substantial excess absolute risk of mortality per 10,000 person-years was identified: overall 95.5; death due to HL 38.3, second malignant neoplasms 23.9, and cardiovascular disease 13.1. Risks for overall mortality included radiation dose ≥ 3000 rad ( ≥ 30 Gy; supra-diaphragm: HR, 3.8; 95% CI, 1.1-12.6; infradiaphragm + supradiaphragm: HR, 7.8; 95% CI, 2.4-25.1), exposure to anthracycline (HR, 2.6; 95% CI, 1.6-4.3) or alkylating agents (HR, 1.7; 95% CI, 1.2-2.5), non-breast second malignant neoplasm (HR, 2.6; 95% CI 1.4-5.1), or a serious cardiovascular condition (HR, 4.4; 95% CI 2.7-7.3). Excess mortality from second neoplasms and cardiovascular disease vary by sex and persist > 20 years of follow-up in childhood HL survivors.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): J. Natl. Cancer Inst.
                Title: Journal of the National Cancer Institute
                Publisher: Oxford University Press (OUP)
                ISSN (Electronic): 1460-2105
                ISSN (Print): 0027-8874
                Publication date (Electronic): Nov 2014
                Volume: 106
                Issue: 11
                Affiliations
                [1 ] Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW). alp49@georgetown.edu.
                [2 ] Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
                Article
                Publisher Item ID: dju300
                DOI: 10.1093/jnci/dju300
                PMC ID: 4200030
                PubMed ID: 25301964
                SO-VID: 891d7a9e-cacc-4c50-80d9-852bc33dac99
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