It is the objective of these studies to improve the treatment outcomes for patients with newly diagnosed Hodgkin's disease and to continue to monitor the late effects of treatment on adults and children participating in past and present clinical trials. We intend to accomplish these goals through the conduct of novel therapeutic studies and the maintenance of a database on over 2500 Hodgkin's disease patients. The proposed clinical studies build upon our previous research efforts in Hodgkin's disease. A novel treatment for adults with early stage disease has been designed to maintain high cure rates, limit staging, and reduce late effects. This treatment, which consists of just eight weeks of chemotherapy followed by lower dose, modified involved field irradiation, is based on the success of abbreviated chemotherapy and limited irradiation in advanced stage disease. We plan to continue to study the abbreviated chemotherapy program, Stanford U, alone or in combination with irradiation in unfavorable and advanced stage Hodgkin's disease. Preliminary data indicate that this treatment approach is highly effective and, to date, has not been associated with serious morbidity. In the adult studies we plan to incorporate potentially more sensitive nuclear imaging for the identification of Hodgkin's disease and assessing the risk for relapse following the described treatments. Similar to adults, children with Hodgkin's disease will be treated according to risk group on clinical trials conducted at Stanford University, St. Jude Children's Research Hospital and the Dana Farber Cancer Center. Those patients with favorable, limited disease will receive four cycles of chemotherapy and low dose irradiation while an alternating chemotherapy program and low dose irradiation will be used for patients with unfavorable or advanced disease. Follow-on studies are planned for each of the clinical trials in progress in adults and children. An integral part of this application is the continued follow up of patients enrolled on prospective clinical trials at Stanford University since 1962. This includes the description of relapses, subsequent therapies, late morbidity, fatal treatment complications, causes of death and survival in over 2500 treated patients. These data, which have allowed Stanford investigators to make seminal observations on late effects such as second malignancy and cardiac disease, are maintained in a sophisticated database, representing a national resource for the efficacy and complications of the treatment of Hodgkin's disease.
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