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Background and Objectives: Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life, with long term follow up. We assess the impact of prognostic factors associated with local treatment failure of pediatric HL patients with unfavorable criteria treated with combined modality: Alternating ABVD (Doxorubicin, Bleomycin, Vinblastine and Decarbazine) and COEP (Cyclophosphamide, Oncovin, Etoposide and Prednisone) chemotherapy and response-based, involved-field radiation for newly diagnosed unfavorable pediatric HL patients, also will detect toxicities and long-term complications observed in the patients. Methods: This prospective study was carried out from January 2010 to January 2018, with a median follow up of 74 months (range 8 - 103 months). 54 patients were eligible for this study stratified into two groups: intermediate risk (IR) and high-risk group (HR). Patients were treated with (4 - 6 cycles) and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved a partial response. Results: 27 patients were IR and 27 patients were HR. There were 16 treatment failures; 5 patients had progressive disease; and 11 patients had a relapse. 9 patients died from their disease progression. The 5-year overall survival (OS) and event-free survival (EFS) rates (±SE) were 81.8% ± 5.7% and 71.8% ± 6.2% respectively. Multivariate analysis revealed that the only independent factor for inferior OS was radiotherapy. Conclusion: Treatment results of unfavourable HL patients in our study are satisfactory for with IR group but not for HR group who needs intensification of therapy. Radiotherapy is considered as a cornerstone in the treatment of the patients with unfavourable How to cite this paper: Ali, A.M., Mohamed, A.M., Ahmed, S., Abdallah, M., Alsaba, T.M. and Mansour, S. (2018) RiskAdapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom. Journal of Cancer Therapy, 9, 545-558. https://doi.org/10.4236/jct.2018.97046 Received: May 24, 2018 Accepted: July 7, 2018 Published: July 10, 2018 Copyright © 2018 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access A. M. Ali et al. DOI: 10.4236/jct.2018.97046 546 Journal of Cancer Therapy criteria with better assessment of early responders needed by PET-CT to identify patients at risk for relapse.

Background and Objectives: Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life, with long term follow up. We assess the impact of prognostic factors associated with local treatment failure of pediatric HL patients with unfavorable criteria treated with combined modality: Alternating ABVD (Doxorubicin, Bleomycin, Vinblastine and Decarbazine) and COEP (Cyclophosphamide, Oncovin, Etoposide and Prednisone) chemotherapy and response-based, involved-field radiation for newly diagnosed unfavorable pediatric HL patients, also will detect toxicities and long-term complications observed in the patients. Methods: This prospective study was carried out from January 2010 to January 2018, with a median follow up of 74 months (range 8 - 103 months). 54 patients were eligible for this study stratified into two groups: intermediate risk (IR) and high-risk group (HR). Patients were treated with (4 - 6 cycles) and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved a partial response. Results: 27 patients were IR and 27 patients were HR. There were 16 treatment failures; 5 patients had progressive disease; and 11 patients had a relapse. 9 patients died from their disease progression. The 5-year overall survival (OS) and event-free survival (EFS) rates (±SE) were 81.8% ± 5.7% and 71.8% ± 6.2% respectively. Multivariate analysis revealed that the only independent factor for inferior OS was radiotherapy. Conclusion: Treatment results of unfavourable HL patients in our study are satisfactory for with IR group but not for HR group who needs intensification of therapy. Radiotherapy is considered as a cornerstone in the treatment of the patients with unfavourable How to cite this paper: Ali, A.M., Mohamed, A.M., Ahmed, S., Abdallah, M., Alsaba, T.M. and Mansour, S. (2018) RiskAdapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom. Journal of Cancer Therapy, 9, 545-558. https://doi.org/10.4236/jct.2018.97046 Received: May 24, 2018 Accepted: July 7, 2018 Published: July 10, 2018 Copyright © 2018 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access A. M. Ali et al. DOI: 10.4236/jct.2018.97046 546 Journal of Cancer Therapy criteria with better assessment of early responders needed by PET-CT to identify patients at risk for relapse.

Background and Objectives: Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life, with long term follow up. We assess the impact of prognostic factors associated with local treatment failure of pediatric HL patients with unfavorable criteria treated with combined modality: Alternating ABVD (Doxorubicin, Bleomycin, Vinblastine and Decarbazine) and COEP (Cyclophosphamide, Oncovin, Etoposide and Prednisone) chemotherapy and response-based, involved-field radiation for newly diagnosed unfavorable pediatric HL patients, also will detect toxicities and long-term complications observed in the patients. Methods: This prospective study was carried out from January 2010 to January 2018, with a median follow up of 74 months (range 8 - 103 months). 54 patients were eligible for this study stratified into two groups: intermediate risk (IR) and high-risk group (HR). Patients were treated with (4 - 6 cycles) and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved a partial response. Results: 27 patients were IR and 27 patients were HR. There were 16 treatment failures; 5 patients had progressive disease; and 11 patients had a relapse. 9 patients died from their disease progression. The 5-year overall survival (OS) and event-free survival (EFS) rates (±SE) were 81.8% ± 5.7% and 71.8% ± 6.2% respectively. Multivariate analysis revealed that the only independent factor for inferior OS was radiotherapy. Conclusion: Treatment results of unfavourable HL patients in our study are satisfactory for with IR group but not for HR group who needs intensification of therapy. Radiotherapy is considered as a cornerstone in the treatment of the patients with unfavourable How to cite this paper: Ali, A.M., Mohamed, A.M., Ahmed, S., Abdallah, M., Alsaba, T.M. and Mansour, S. (2018) RiskAdapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom. Journal of Cancer Therapy, 9, 545-558. https://doi.org/10.4236/jct.2018.97046 Received: May 24, 2018 Accepted: July 7, 2018 Published: July 10, 2018 Copyright © 2018 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access A. M. Ali et al. DOI: 10.4236/jct.2018.97046 546 Journal of Cancer Therapy criteria with better assessment of early responders needed by PET-CT to identify patients at risk for relapse.

Background and Objectives: Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life, with long term follow up. We assess the impact of prognostic factors associated with local treatment failure of pediatric HL patients with unfavorable criteria treated with combined modality: Alternating ABVD (Doxorubicin, Bleomycin, Vinblastine and Decarbazine) and COEP (Cyclophosphamide, Oncovin, Etoposide and Prednisone) chemotherapy and response-based, involved-field radiation for newly diagnosed unfavorable pediatric HL patients, also will detect toxicities and long-term complications observed in the patients. Methods: This prospective study was carried out from January 2010 to January 2018, with a median follow up of 74 months (range 8 - 103 months). 54 patients were eligible for this study stratified into two groups: intermediate risk (IR) and high-risk group (HR). Patients were treated with (4 - 6 cycles) and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved a partial response. Results: 27 patients were IR and 27 patients were HR. There were 16 treatment failures; 5 patients had progressive disease; and 11 patients had a relapse. 9 patients died from their disease progression. The 5-year overall survival (OS) and event-free survival (EFS) rates (±SE) were 81.8% ± 5.7% and 71.8% ± 6.2% respectively. Multivariate analysis revealed that the only independent factor for inferior OS was radiotherapy. Conclusion: Treatment results of unfavourable HL patients in our study are satisfactory for with IR group but not for HR group who needs intensification of therapy. Radiotherapy is considered as a cornerstone in the treatment of the patients with unfavourable How to cite this paper: Ali, A.M., Mohamed, A.M., Ahmed, S., Abdallah, M., Alsaba, T.M. and Mansour, S. (2018) RiskAdapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom. Journal of Cancer Therapy, 9, 545-558. https://doi.org/10.4236/jct.2018.97046 Received: May 24, 2018 Accepted: July 7, 2018 Published: July 10, 2018 Copyright © 2018 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access A. M. Ali et al. DOI: 10.4236/jct.2018.97046 546 Journal of Cancer Therapy criteria with better assessment of early responders needed by PET-CT to identify patients at risk for relapse.

Introduction: Chordoma are rare, slowly growing, locally aggressive neoplasms of bone that arise from embryonic remnants of the notochord. This work aimed to evaluate the treatment results of a series of chordoma patients in our institute. More also, we try to clarify the importance of approaching such patients through a multidisciplinary team to maximize the oncologic and functional outcomes and to improve the patient's quality of life. Patients and Methods: This study was conducted at SECI, surgical department during a period of 6 years duration. Patients were treated through multi-disciplinary team specialists of our cancer institute. Surgery and postoperative radiation therapy was offered to all patients. Results: Results involves 8 patients with an average follow-up interval of 38.5 months. We had four cases of local recurrence which was salvaged with re-surgery and/or adjuvant radiotherapy. We had no postoperative motor neurologic deficit, with an excellent sphincter control in all patients. The 3-year survival rate in this study is 87.5%. Conclusions: Multi-disciplinary treatment approach for chordoma is fundamental to improve overall outcomes. Surgery continues to be the primary modality in the management of chordoma. Rates of local recurrence, as well as survival, appear to be dependent on the achievement of negative surgical margins. Patients who relapse locally may have a poor prognosis but both radiation and surgery can be used as salvage therapy.

Introduction: Chordoma are rare, slowly growing, locally aggressive neoplasms of bone that arise from embryonic remnants of the notochord. This work aimed to evaluate the treatment results of a series of chordoma patients in our institute. More also, we try to clarify the importance of approaching such patients through a multidisciplinary team to maximize the oncologic and functional outcomes and to improve the patient's quality of life. Patients and Methods: This study was conducted at SECI, surgical department during a period of 6 years duration. Patients were treated through multi-disciplinary team specialists of our cancer institute. Surgery and postoperative radiation therapy was offered to all patients. Results: Results involves 8 patients with an average follow-up interval of 38.5 months. We had four cases of local recurrence which was salvaged with re-surgery and/or adjuvant radiotherapy. We had no postoperative motor neurologic deficit, with an excellent sphincter control in all patients. The 3-year survival rate in this study is 87.5%. Conclusions: Multi-disciplinary treatment approach for chordoma is fundamental to improve overall outcomes. Surgery continues to be the primary modality in the management of chordoma. Rates of local recurrence, as well as survival, appear to be dependent on the achievement of negative surgical margins. Patients who relapse locally may have a poor prognosis but both radiation and surgery can be used as salvage therapy.