[en] Over the past 25 years there have been dramatic improvements in our understanding of the epidemiology, biology, natural history, and treatment of Hodgkins disease. Hodgkin's disease is one of the few cancers where both chemotherapy and radiation therapy have provided dramatic improvements in cure of this once uniformly fatal disease. Part 1 of the refresher course on Hodgkin's disease will include a review of: 1) New Findings in epidemiology, immunohistochemistry and molecular biology of the Reed-Sternberg cell including association with Epstein-Barr virus; 2) Review of pathology including discussions of NS 1 vs NS2, and nodular LP subclassifications; 3) Recommendations for staging including the role of staging laparotomy in Hodgkin's disease; 4) Standard techniques for commonly used radiation therapy fields for Hodgkin's disease and 5) Treatment of early stage Hodgkin's disease including an overview on recent and current clinical trials

[en] Part I of the refresher course on Hodgkin's disease (HD) will: 1. Update the epidemiology, review the theories regarding the etiology and discuss new development in the histologic classification of HD. 2. Review the modifications of staging system and discuss the role of staging laparotomy and the implications of modern imaging information. 3. Review the alternatives for treatment of early-stage HD and results of recent clinical trials. 4. Review principles and techniques of radiation therapy that are relevant to the management of HD

[en] Part II of the refresher course on Hodgkin's disease (HD) will: 1. Update chemotherapy principles and new regimens for HD. 2. Discuss the role and practice of radiation therapy in the management of stage III-IV disease. 3. Review the treatment of relapsed Hodgkin's disease after radiotherapy alone and the salvage approach to failures of primary chemotherapy and combined modality therapy. 4. Examine the role of radiation therapy in high-dose salvage programs with stem cell rescue. 5. Review the long-term complications of all modalities with an emphasis on secondary breast cancer and coronary heart disease

[en] Over the past 25 years there have been dramatic improvements in our understanding of the epidemiology, biology, natural history, and treatment of Hodgkin's disease. Hodgkin's disease is one of the few cancers where both chemotherapy and radiation therapy have provided dramatic improvements in the cure of this once uniformly fatal disease. Part 2 of the refresher course on Hodgkin's disease will include a review of: 1) Treatment of stage III and IV disease including the role of radiation therapy alone for stage III disease 2) The role of adjuvant radiation therapy in advanced Hodgkin's disease 3) The use of different chemotherapy regimens including MOPP vs ABVD, ABVD vs hybrid chemotherapy, and the development of new chemotherapy regimens 4) Treatment of refractory and relapsed Hodgkin's disease including prognostic factors and role of salvage chemotherapy vs. high dose therapy and hematopoietic stem cell rescue and 5) An overview of the long-term complications of treatment and their impact on new strategies for treatment for Hodgkin's disease

[en] Payers are increasingly interested in knowing whether they are receiving value for the dollars they spend on health care. Because economic analyses will be used as a means of evaluating radiation therapy, it is important that radiation oncologists understand the basic methodology employed in such analyses. This review article describes the four basic types of economic analyses: cost minimization, cost effectiveness, cost utility, and cost benefit. Specification of alternative therapies, choice of perspective of the analysis, measurements of costs and benefits, and the role of discounting and sensitivity analyses are discussed. Published economic analyses that pertain directly to treatment with radiation therapy are reviewed. Finally, we close with a brief discussion of the potential areas for future economic outcomes research in radiation oncology

[en] Part II of the refresher course on Hodgkin's disease (HD) will: 1. Update chemotherapy principles and new regimens for HD. 2. Discuss the role and practice of radiation therapy in the management of stage III-IV disease. 3. Review the treatment of relapsed Hodgkin's disease after radiotherapy alone and the salvage approach to failures of primary chemotherapy and combined modality therapy. 4. Examine the role of radiation therapy in high-dose salvage programs with stem cell rescue. 5. Review the long-term complications of all modalities with an emphasis on secondary breast cancer and coronary heart disease

[en] Part I of the refresher course on Hodgkin's disease (HD) will: 1. Update the epidemiology, review the theories regarding the etiology and discuss new development in the histologic classification of HD. 2. Review the modifications of staging system and discuss the role of staging laparotomy and the implications of modern imaging information. 3. Review the alternatives for treatment of early-stage HD and results of recent clinical trials. 4. Review principles and techniques of radiation therapy that are relevant to the management of HD

[en] Purpose: Patients with relapsed acute myelogenous leukemia (AML), who are not eligible for bone marrow transplantation, have a poor prognosis when treated with chemotherapy alone. Total body irradiation (TBI) is an effective modality against AML when used in doses of 1000-1400 cGy with hematopoietic stem cell support. We undertook a phase I study of TBI with granulocyte-colony-stimulating factor (G-CSF) support, without stem cell support in patients with AML either in relapse or second or subsequent remission. Methods and Materials: Patients with relapsed AML, or AML in second or subsequent remission were treated in a phase I study of TBI followed by G-CSF. The first dose level was 200 cGy. After the initial cohort of patients it was clear that patients with overt leukemia did not benefit from this treatment, and subsequent patients were required to be in remission at the time of TBI. Results: Eleven patients were treated, 4 in overt relapse, and 7 in remission. 200 cGy was used in all, and dose escalation was not possible due to prolonged thrombocytopenia in all patients but one. Neutrophil recovery was adequate in those patients who remained in remission after TBI. Patients with overt leukemia had transient reduction in blast counts, but rapid recurrence of their leukemia. Patients treated in remission had short remissions, with the exception of one patient who is in remission 32 months after treatment. Conclusion: There is some antileukemic effect of TBI even at 200 cGy, though this dose appears to be too low to help a significant number of patients. If TBI is to be escalated without stem cell support, then a thrombopoietic agent will need to be used

[en] The bone marrow is an important dose-limiting cell renewal tissue for chemotherapy, wide-field irradiation, and autologous bone marrow transplantion. Over the past 5-10 years a great deal has been discovered about the hematopoietic stem cell compartment. Although the toxicity associated with prolonged myelosuppression continues to limit the wider use of chemotherapy and irradiation, ways are being discovered to circumvent this toxicity such as with the increasing use of cytokines. This review describes what is known of how chemotherapy and irradiation damage stem cells and the microenvironment, how cytokines protect hematopoietic cells from radiation damage and speed marrow recovery after chemotherapy or marrow transplantation, and how various types of blood marrow cells contribute to engraftment and long-term hematopoiesis after high doses of cytotoxic agents and/or total body irradiation

[en] Purpose: Using a cost-effectiveness analysis, to weigh the costs and benefits of the different staging and treatment options in early-stage Hodgkin's disease. Methods: We constructed a decision-analytic model for a hypothetical cohort of 25-year-old patients with early-stage Hodgkin's disease. Markov models were used to simulate the lifetime costs and prognosis of each staging and treatment strategy. Baseline probabilities and cost estimates were derived from published studies and bills of relevant patient cohorts. Results: Among the six management strategies considered, the incremental cost-effectiveness ratio of laparotomy and tailored treatment compared with mantle and para-aortic-splenic radiation therapy in all clinical stage I-II patients was $24,100/quality-adjusted life year, while that of the strategy of combined modality therapy in all clinical stage I-II patients compared with laparotomy was $61,700/quality-adjusted life year. All the remaining strategies were dominated by one of these three strategies. Sensitivity analysis showed that the cost-effectiveness ratios were driven predominantly by the effectiveness rather than the cost of each strategy. In particular, the analysis was heavily influenced by the utility of the post-laparotomy health state. Conclusions: In considering the various alternative management strategies in early-stage Hodgkin's disease, even very small gains in effectiveness were enough to justify the additional costs of more expensive treatment options