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OBJECTIVE To define the scope of combined therapy in patients having local Hodgkin's disease (LHD) with massive mediastinal lesion. METHODS From 1980 to 1997 the treatment was given to 75 LHD patients with massive lesion of the mediastinum (mediastinal-thoracic index, MTI, > or = 0.33). The patients have received combined chemoradiotherapy according to 3 cycle CVPP (cyclophosphamide 600 mg/m2, vinblastine 6 mg/m2, prokarbasin 100 mg/m2, prednisolone 40 mg/m2) with a 2-week interval + radiation to all the lymphatic collectors above the diaphragm with a single focal dose 2 Gy to total focal dose 36-38 Gy + 3 cycle CVPP. According to the size of the mediastinum the patients were divided into 3 groups: group 1--MTI = 0.33, 27 patients; group 2--MTI = 0.33 > 0.45, 32 patients; group 3--MTI > or = 0.45, 16 patients. The response was estimated according to the latest EORTC recommendations. Survival curves were plotted according to the E.L. Kaplan and P. Meier procedure. RESULTS Complete remission was achieved in 93, 94 and 56% of group 1, 2 and 3 patients, respectively. 6-year recurrence-free survival reached 84, 71 and 32%, while survival free of treatment failure 80, 66 and 27%, respectively. 6-year overall survival and uneventful survival made up 94, 97 and 70%; 72, 66 and 27%, respectively. CONCLUSIONS Treatment of LHD patients of group 1 is performed according to the standard scheme (6 cycles of first-line polychemotherapy plus radiotherapy). Patients of group 2 can be treated more intensively, while for patients of group 3 more intensive treatment is a treatment of choice.
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