{"id":674,"date":"2010-11-15T13:32:01","date_gmt":"2010-11-15T12:32:01","guid":{"rendered":"http:\/\/www.pjh.fr\/wordpress\/?p=674"},"modified":"2011-10-19T01:39:09","modified_gmt":"2011-10-18T23:39:09","slug":"hd10-hodgkin-localises-stades-favorables-2-abvd-20-gy-if-le-nouveau-gold-standard","status":"publish","type":"post","link":"http:\/\/www.pjh.fr\/wordpress\/?p=674","title":{"rendered":"HD10 &#8211; Hodgkin localis\u00e9s stades favorables : 2 ABVD + 20 Gy IF, le nouveau gold standard ?"},"content":{"rendered":"<p>C&rsquo;\u00e9tait\u00a0 la semaine du Hodgkin sur le NEJM en ao\u00fbt dernier (363;7 12 ao\u00fbt 2010) avec la publication de l&rsquo;essai allemand pr\u00e9sent\u00e9 \u00e0 l&rsquo;ASH 2009 dont nous avions d\u00e9j\u00e0 parl\u00e9 (sur la pr\u00e9c\u00e9dente version du site) : <strong>1370 patients<\/strong> (excusez du peu, \u00e7a laissera r\u00eaveur tous les investigateurs fran\u00e7ais&#8230;) pr\u00e9sentant un <strong>lymphome de Hodgkin stade I ou II <span style=\"text-decoration: underline;\">sans <\/span>facteur de risque du GHSG<\/strong> (German Hodgkin Study group) (cf tableau 1) \u00e2g\u00e9s de <strong>16 \u00e0 75 ans<\/strong>.<\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"4\" align=\"center\">\n<tbody>\n<tr>\n<td><strong>Tableau 1 &#8211; Facteurs de risque du GHSC<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\n<ul>\n<li>Grosse masse m\u00e9diastinale (\u2265 1\/3 du diam\u00e8tre thoracique maximal)<\/li>\n<li>Maladie avec extension extra-ganglionnaire (les stades \u00ab\u00a0EN\u00a0\u00bb)<\/li>\n<li>\u2265 3 aires ganglionnaires atteintes**<\/li>\n<li>VS augment\u00e9e (\u2265 50 mm\/h pour stades IA, IIA et \u2265 30 mm\/h pour stades IB)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td><em>** Aires gangli<\/em>onnaires (\u2260 Ann Arbor)<\/p>\n<p style=\"text-align: center;\"><a href=\"http:\/\/www.pjh.fr\/wordpress\/wp-content\/uploads\/2010\/08\/areale_en.png\" rel=\"lightbox[674]\"><img loading=\"lazy\" class=\"size-full wp-image-676 aligncenter\" title=\"areale_en\" src=\"http:\/\/www.pjh.fr\/wordpress\/wp-content\/uploads\/2010\/08\/areale_en.png\" alt=\"\" width=\"452\" height=\"262\" srcset=\"http:\/\/www.pjh.fr\/wordpress\/wp-content\/uploads\/2010\/08\/areale_en.png 452w, http:\/\/www.pjh.fr\/wordpress\/wp-content\/uploads\/2010\/08\/areale_en-300x173.png 300w\" sizes=\"(max-width: 452px) 100vw, 452px\" \/><\/a><\/p>\n<ul>\n<li>Aire A : cervicale droite + infra-\/supra-claviculaire\/nucale droite<\/li>\n<li>Aire B : cervicale gauche + infra-\/supra-claviculaire\/nucale gauche<\/li>\n<li>Aire C : droite\/gauche hilaire<\/li>\n<li>Aire D : axillaire droite<\/li>\n<li>Aire E : axillaire gauche<\/li>\n<li>Aire F : abdominale haute (hile h\u00e9patique, spl\u00e9nique ou c\u0153liaque)<\/li>\n<li>Aire G : abdominale basse<\/li>\n<li>Aire H : iliaque droite<\/li>\n<li>Aire I : iliaque gauche<\/li>\n<li>Aire K : inguinale + f\u00e9morale droite<\/li>\n<li>Aire L : inguinale + f\u00e9morale gauche<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Le suivi m\u00e9dian est de 7.5 ans.<\/strong><\/p>\n<p>Comme il s&rsquo;agit d&rsquo;un essai allemand, il y a toujours un certain nombre de bras (jamais 2, trop einfach&#8230;), au moins 4&#8230;<\/p>\n<ol>\n<li>ABVD x 4 + Radioth\u00e9rapie involved-field (IF) 30 Gy<\/li>\n<li>ABVD x 4 + Radioth\u00e9rapie IF 20 Gy<\/li>\n<li>ABVD x 2 + Radioth\u00e9rapie IF 30 Gy<\/li>\n<li>ABVD x 2 + Radioth\u00e9rapie IF 20 Gy<\/li>\n<\/ol>\n<p><strong>And the winner is&#8230; Groupe 4, ABVD x 2 + 20 Gy<\/strong>&#8230;<\/p>\n<p>Car :<\/p>\n<ul>\n<li><strong>moins toxique<\/strong>\n<ul>\n<li><strong>toxicit\u00e9 aigu\u00eb s\u00e9v\u00e8re<\/strong> :<strong> ABVD x2 = 33.2%<\/strong> vs<strong> ABVD x4 = 51,7%<\/strong><br \/>\n<strong>20 Gy 2.9% vs 30 Gy 8.7%)<\/strong><em><br \/>\n<\/em><\/p>\n<ul>\n<li>Alop\u00e9cie : 15% vs 28%<\/li>\n<li>Cytop\u00e9nies : 15% vs 24% &#8211; infections : 1.7% vs 5.1\u00b5<\/li>\n<\/ul>\n<\/li>\n<li>Pas de diff\u00e9rences pour les cancers secondaires mais avec un recul de seulement 7.5 ans (55 patients : 38 tumeurs solides, 15 LMNH, 2 LAM). <em>La cause principale de d\u00e9c\u00e8s est la n\u00e9oplasie secondaire (11 d\u00e9c\u00e8s) devant le lymphome de Hodgkin (10 d\u00e9c\u00e8s) puis les \u00e9v\u00e9nements cardiovasculaires (9), la toxicit\u00e9 du traitement de 1\u00e8re ligne (7) et la toxicit\u00e9 des traitements ult\u00e9rieurs (5).<br \/>\n<\/em><\/li>\n<\/ul>\n<\/li>\n<li><strong>Aussi efficace : pas de diff\u00e9rence entre les 4 groupes pour les taux de r\u00e9ponse, progression et rechute<\/strong><\/li>\n<\/ul>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"4\" align=\"center\">\n<tbody>\n<tr>\n<td colspan=\"2\">Pour les 1190 patients :<\/td>\n<\/tr>\n<tr>\n<td>R\u00e9mission compl\u00e8te<\/td>\n<td>96.6%<\/td>\n<\/tr>\n<tr>\n<td>R\u00e9mission partielle<\/td>\n<td>0.7%<\/td>\n<\/tr>\n<tr>\n<td>Non r\u00e9pondeur<\/td>\n<td>0.7%<\/td>\n<\/tr>\n<tr>\n<td>Taux de rechute<\/td>\n<td>6% (71\/1190)<\/td>\n<\/tr>\n<tr>\n<td>PFS 5 ans<\/td>\n<td>92.4%<\/td>\n<\/tr>\n<tr>\n<td>PFS 8 ans<\/td>\n<td>87.6%<\/td>\n<\/tr>\n<tr>\n<td>Survie globale \u00e0 5 ans<\/td>\n<td>96.8%<\/td>\n<\/tr>\n<tr>\n<td>Survie globale \u00e0 8 ans<\/td>\n<td>94.5%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>En annexe :<\/p>\n<p>&#8211; causes de d\u00e9c\u00e8s dans la phase aigu\u00eb : fibrose pulmonaire (3), sepsis (2), pneumopathie (1), cause non connue (1)<\/p>\n<p>&#8211; causes de d\u00e9c\u00e8s \u00e0 long terme : 57 d\u00e9c\u00e8s (n\u00e9oplasie secondaire 11, Hodgkin 10, cardio-vasculaire 9, toxicit\u00e9 du traitement de premi\u00e8re ligne 7, toxicit\u00e9 du traitement de rattrapage 5)<br \/>\n<\/p>\n<div class=\"pdf24Plugin-cp\"> \t<form name=\"pdf24Form0\" method=\"post\" action=\"https:\/\/doc2pdf.pdf24.org\/wordpress.php\" target=\"pdf24PopWin\" onsubmit=\"var pdf24Win = 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(sur la pr\u00e9c\u00e9dente version du site) : 1370 patients (excusez du peu, \u00e7a laissera r\u00eaveur tous les investigateurs fran\u00e7ais&#8230;) pr\u00e9sentant un lymphome de Hodgkin stade [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":696,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[87],"tags":[69,67],"_links":{"self":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/674"}],"collection":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=674"}],"version-history":[{"count":12,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/674\/revisions"}],"predecessor-version":[{"id":777,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/674\/revisions\/777"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/media\/696"}],"wp:attachment":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=674"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=674"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=674"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}