Aim of Work: This study is a prospective randomized trial aiming to investigate whether radiotherapy volume can be reduced without loss of efficacy from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) after four cycles of ABVD chemotherapy in the treatment of early stage Hodgkin's lymphoma. Patients and Methods: Between September 2009 and January 2012, all patients with newly diagnosed early-stage favorable and unfavorable Hodgkin's lymphoma attending to the Clinical Oncology department of Cairo University, faculty of medicine were enrolled into this study after a written consent was obtained from those cases enrolled. Patients were assigned to receive (ABVD) for four cycles followed by randomization for radiotherapy into two arms one arm of 30 Gy INRT +/− 6 Gy to residual disease or another arm of 30 Gy IFRT +/− 6 Gy to residual disease. Results: 35 patients were enrolled in this study: 16 patients in the INRT arm and 19 patients in the IFRT arm. The median observation time was 25 months. The overall survival for all eligible patients was 97% and freedom from treatment failure was 85.7%. Survival rates at the end of the study revealed no differences between INRT and IFRT arms. Also, in terms of complete remission post radiotherapy (14 versus 15), relapse (1 versus 4), and death (0 versus 1) respectively the outcome was similar in both arms. As regard acute and sub-acute toxicities no significant difference could be detected between both arms except that IFRT arm was associated with a higher incidence of radiation pneumonitis (4 versus 1 patient). Conclusion: Radiotherapy volume size reduction from IFRT to INRT after ABVD chemotherapy for four cycles produces similar results and less toxicity in patients with early-stage Hodgkin's lymphoma especially in patients with mediastinal disease.
The aim of this study is to conduct a comparison study between the efficacy and safety of zoledronic acid and clodronate in malignant hypercalcemia secondary to bone metastases in Egyptian adult patients. This is a prospective observational study conducted 80 patients (40 in each group), who were assigned to receive either zoledronic acid (4 mg over a 30 min infusion) every 3-4 weeks or clodronate (a single dose of 1,500 mg over a 4 h infusion) monthly for 3 months. The primary efficacy analysis was the proportion of patients with at least one skeletal-related event. The safety was assessed based on the frequencies of the reported adverse effects as nausea, vomiting, anemia, etc. The calcium level significantly decreased in both groups. At least one skeletal-related event occurred in 15 (37.5%) patients receiving zoledronic acid and 32 (80%) patients receiving clodronate. Radiotherapy and fractures represented the highest event observed in both groups. At least one adverse event was experienced by 20 (50%) patients treated with zoledronic acid, while 26 (65%) patients on clodronate recorded one or more adverse event. Pyrexia was the most commonly reported side effect and flare phenomena. Both treatment groups were comparable regarding the reported adverse events. Both medications did not show any significant nephrotoxicity detected by elevation in the creatinine level. Zoledronic acid and clodronate have demonstrated clinical utility in the treatment of hypercalcaemia in cancer patients. Zoledronic acid provides a more effective and convenient treatment than clodronate, while both maintaining a similar safety profile.
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